Union West Surgery Center forms
Please follow the steps below to complete Phase I - Clinical Privileges Update 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
- Danielle De La Rosa - danielle.delarosa@atriumhealth.org
- Jan Horai - jan.horai@atriumhealth.org
- Katrina Barkley - katrina.barkley@atriumhealth.org
- Megan Houser- megan.houser@atriumhealth.org
- Shauna Guy Noel - shauna.guynoel@atriumhealth.org
- Staci Hightower - staci.hightower@atriumhealth.org
If you have additional questions you may contact Staci Hightower, Supervisor here.
Physician Forms:
Advanced Practice Provider (APP) Forms:
UW Certified Registered Nurse Anesthetist (CRNA)
Thank you for your commitment to Atrium Health!