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 Anesthesia

COS General Surgery, Breast Oncology

COS Orthopaedics

Advance Practice Provider (APP) Forms

COS Anesthesia Assistant

COS Certified Registered Nurse Practitioner (C.R.N.A.)

COS Physician Assistant (P.A.)

Thank you for your commitment to Atrium Health!