Delineation of Privileges Request

To request an update to your current delineation of privilege(s) form to include new privileges at one or more of the Carolinas HealthCare system facilities please complete and submit this form. To request a change in classification or to request clinical privileges at any or all of the Atrium Health facilities please complete and submit this form. Please note that you must have current membership at one of the Atrium Health facilities listed.

You can begin performing newly requested clinical procedures once an approval/clearance notification is received from Medical Staff Services.

Please allow up to thirty (30) days for your request to be processed.