Center for Orthopaedic Surgery Forms
Please follow the steps below to complete Phase I - Clinical Privileges Update of the reappointment process for Center for Orthopaedic Surgery (COS) privileges.
If you are requesting a privilege you currently do not have, you must meet the initial criteria for that privilege.
- Print and complete the Delineation of Privileges (DOP) that reflects your specialty/current practice.
- Return the form(s) to the coordinator assigned to you.
- Allison Eury - Allison.Eury@AtriumHealth.org
- Demetrice Ford - Demetrice.Ford@AtriumHealth.org
If you have additional questions, you may email Staci Hightower, Supervisor.
Physician Forms
COS General Surgery, Breast Oncology
Advance Practice Provider (APP) Forms
COS Certified Registered Nurse Practitioner (C.R.N.A.)
COS Physician Assistant (P.A.)
Thank you for your commitment to Atrium Health!