ARTICLE 3 PROCEDURE FOR INITIAL APPOINTMENT AND PRIVILEGES
3 . A . APPLICATION 3 . A . 1 . Application Form :
( a ) Application forms for appointment , reappointment , and clinical privileges will be approved by the Board , upon recommendation by the Credentials Committee and MEC .
( b ) The applications for initial appointment , reappointment , and clinical privileges existing now , and as may be revised , are incorporated by reference and made a part of this Manual .
( c ) The application will contain a request for specific clinical privileges and will require detailed information concerning the applicant ’ s professional qualifications . The applicant will sign the application and certify that they are able to perform the privileges requested and the responsibilities of appointment .
( d ) In addition to other information , the following may be considered :
( 1 ) information as to whether the applicant ’ s appointment or clinical privileges have been voluntarily or involuntarily relinquished , withdrawn , denied , revoked , suspended , subjected to probationary or other conditions , reduced , limited , terminated , or not renewed at any other hospital , health care facility , or other organization , or are currently being investigated or challenged ;
( 2 ) licensure status in all current or past states of licensure ;
( 3 ) information as to whether the applicant ’ s license to practice any relevant profession in any state , DEA registration , or any state ’ s controlled substance license has been voluntarily or involuntarily suspended , modified , terminated , restricted , or relinquished or is currently being investigated or challenged ;
( 4 ) information from the AMA or AOA Physician Profile ;
( 5 ) information concerning the applicant ’ s professional liability litigation experience , including past and pending claims , final judgments , or settlements ; the substance of the allegations as well as the findings and the ultimate disposition ; and any additional information concerning such proceedings or actions as the Credentials Committee , the MEC , or the Board may request ;
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