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Please follow the steps below to complete Phase I - Clinical Privileges Update of the reappointment process for Atrium Health Surgery Center Shelby privileges.

1) PRINT and COMPLETE - the Delineation of Privileges (DOP) that reflects your specialty/current practice

2) NOTE - if you are requesting a privilege you currently do not have, you must meet the initial criteria for that privilege.

3) RETURN the form(s) to the coordinator assigned to you

 If you have additional questions you may contact Staci Hightower, Supervisor here.

 Physician Forms

Shelby Anesthesia

Shelby Colorectal

Shelby Dermatology

Shelby Endoscopy

Shelby General Surgery

Shelby Gynecology

Shelby Hand Surgery

Shelby Neurosurgery

Shelby Ophthalmology

Shelby Oral Surgery

Shelby Orthopaedics

Shelby Otorhinolaryngology

Shelby Pain Management

Shelby Plastic Surgery

Shelby Podiatry

Shelby Urology


Advanced Clinical Practitioner (ACP) Forms:

Shelby APP Nurse Practitioner (N.P.)

Shelby APP Physician Assistant (P.A.)

Shelby APP Certified Registered Nurse Anesthetist (CRNA)


Thank you for your commitment to Atrium Health!