• Procedural privileges should be listed so applicants and the organization can modify the group of privileges to the applicant ’ s specific expertise .
• Special privileges or advanced privileges and procedures should then be noted . These require additional training , which may include completion of a particular fellowship , manufacturer designated training , or ongoing performance of the procedure with evidence of having performed a required minimum number within a specified timeframe . Some organizations may have monitoring requirements for new privileges or initial professional practice evaluation ( IPPE ), including focused professional practice evaluation ( FPPE ), proctoring or other comparable methods which would also be listed .
• There should also be a provider acknowledgment section . This is a statement signed by the provider requesting the privileges , acknowledging they are currently competent , based on their education and training , board certification , and competency , to perform the privileges requested . Often , this acknowledgment will also have a statement that they agree to abide by the hospital medical staff bylaws , policies and procedures , and rules and regulations . It also indicates that any restriction on the clinical privileges granted to the provider is waived in an emergency situation and in such situations , their actions are governed by the applicable section of the healthcare organizations .
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