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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 Indian Trail.

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

2) NOTE - if you wish to keep a privilege that is attached to maintenance criteria, you must provide proof of that maintenance criteria in order to maintain the privilege

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

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

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

 Physician Forms:

Indian Trail Anesthesia

Indian Trail Obstetrics and Gynecology

Indian Trail Ophthalmology

Indian Trail Oral and Maxillofacial

Indian Trail Orthopaedics

Indian Trail Otolaryngology

Indian Trail Pain Management

Indian Trail Plastic Surgery

Indian Trail Podiatry

Indian Trail Radiology

Indian Trail General Surgery

Indian Trail Urology


Advanced Practice Provider (APP) Forms:

Indian Trail Physician Assistant (P.A.)

Indian Trail Certified Registered Nurse Anesthetist (CRNA)


Thank you for your commitment to Atrium Health!