Union West Surgery Center forms

Please follow the steps below to complete Phase I of the reappointment process for Union West Surgery Center.

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

• Jan Horai - jan.horai@atriumhealth.org
• Joseph Coleman - joseph.coleman@atriumhealth.org
• Katrina Barkley - katrina.barkley@atriumhealth.org
• Megan Brandenburg - megan.brandenburg@atriumhealth.org

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

 Physician Forms:

UW Anesthesia

UW Obstetrics and Gynecology

UW Ophthalmology

UW Oral and Maxillofacial

UW Orthopaedics

UW Otolaryngology

UW Pain Management

UW Plastic Surgery

UW Podiatry

UW Radiology

UW Surgical

UW Urology

Advanced Clinical Practitioner (ACP) Forms:

UW Physician Assistant (P.A.)

UW Certified Registered Nurse Anesthetist (CRNA)

Thank you for your commitment to Atrium Health!