Atrium Health Surgery Center Indian Trail forms

Visitor Guideline Update: Due to respiratory virus season, children 12 and under are not permitted to visit patients in multiple settings. Additionally, everyone is required to mask in patient rooms and other designated areas. Learn more.

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

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.

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.