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    3.16G-Clinical Privileges in Gastroenterology, Endos

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    Amandeep Kaur
    This document outlines the clinical privileges and requirements for gastroenterology and endoscopy at a hospital. It lists the qualifications needed, including the successful completion of training in gastroenterology. It also provides details of the minimum number of previous procedures required in different areas of gastroenterology and endoscopy. The document is to be completed by the applicant physician and includes a section for them to request specific privileges and sign acknowledging their qualifications.

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    3.16G-Clinical Privileges in Gastroenterology, Endos

    Uploaded by

    Amandeep Kaur
    224 views2 pages
    This document outlines the clinical privileges and requirements for gastroenterology and endoscopy at a hospital. It lists the qualifications needed, including the successful completion of training in gastroenterology. It also provides details of the minimum number of previous procedures required in different areas of gastroenterology and endoscopy. The document is to be completed by the applicant physician and includes a section for them to request specific privileges and sign acknowledging their qualifications.

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    3.16G-Clinical Privileges in Gastroenterology,Endoscopy

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    This document outlines the clinical privileges and requirements for gastroenterology and endoscopy at a hospital. It lists the qualifications needed, including the successful completion of training in gastroenterology. It also provides details of the minimum number of previous procedures required in different areas of gastroenterology and endoscopy. The document is to be completed by the applicant physician and includes a section for them to request specific privileges and sign acknowledging their qualifications.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    224 views2 pages

    3.16G-Clinical Privileges in Gastroenterology, Endos

    Uploaded by

    Amandeep Kaur
    This document outlines the clinical privileges and requirements for gastroenterology and endoscopy at a hospital. It lists the qualifications needed, including the successful completion of training in gastroenterology. It also provides details of the minimum number of previous procedures required in different areas of gastroenterology and endoscopy. The document is to be completed by the applicant physician and includes a section for them to request specific privileges and sign acknowledging their qualifications.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 2

    Clinical Privileges in

    Gastroenterology/Endoscopy

    Name of the doctor………………………………………………………………………………


    Initial Appointment

    Reappointment

    Qualifications: Successful completion of a DM/DNB in Gastroenterology from a University recognized by the


    Medical Council of India. For diagnostic gastroenterology work permissions may be given to General
    Surgeons/Internal Medicine Professionals who can demonstrate adequate supervised training in diagnostic
    Gastroenterology and Endoscopy.

    Required Previous Experience: The applicant must have:


     Diagnostic EGD-100 Procedures
     Total Colonoscopy-75 Procedures
     Snare Polypectomy-10 Procedures
     Nonvariceal Haemostasis (Upper and lower); includes 10 active bleeders-20 Procedures
     Variceal Haemostasis (includes 5 active bleeders)-15 Procedures
     Flexible Sigmoidoscopy-25 Procedures
     PEG-10 Procedures
     ERCP (diagnostic)-50 Procedures
     ERCP (therapeutic)-25 Procedures (includes 20 Sphincteromies, 5 Stent placements and is in addition to
    the 75 Diagnostic ERCP procedures)
     Pneumatic Dilation for Achalasia-5 Procedures
     Oesophageal Stent Placement-5 Procedures
     Oesophageal Dilation-Savary Gillard (10) +TTS (5)

    Special Procedures: Successful completion of an approved, recognized course when such exists, or acceptable,
    supervised training in residency, fellowship or other acceptable experience and documentation of competence to
    obtain and retain clinical privileges as set forth in Physician guidelines governing the exercise of specific
    privileges.

    Reappointment/Requirements: Current demonstrated competence and an adequate volume of current


    experience with acceptable results in the privileges requested for the past 24 months based on results of quality
    assessment/improvement activities and outcomes.

    Applicant: Place a check mark in the (R) column for each privilege requested. New applicants must provide
    documentation of the number and types of hospital cases during the past 24 months.

    (R) =Requested (A) =Recommended as Requested (C) =Recommended with Condition (N) =Not
    Recommended
    (Note: If Recommendations for clinical privileges include a condition, modification or are not recommended, the
    specific condition and reason for the same must be stated on the last pages of this form)

    (
    (R) GASTROENTEROLOGY CORE PRIVILEGES (A) (C) N)

    ▫ ▫ ▫ ▫
    Admit, evaluate, diagnose and treatment of patients of all ages, with illnesses,
    injuries and disorders of the Stomach, Intestines and related structures such as the
    Oesophagus, Liver, Gallbladder and Pancreas.
    (
    SPECIAL PROCEDURES (A) (C) N)
    (R)

    ▫ ERCP Diagnostic ▫ ▫ ▫

    Note: Copy at QMS server is controlled.


    Filename & path: /conversion/tmp/scratch/446157570.doc, Date: 11/10/2019
    Clinical Privileges in
    Gastroenterology/Endoscopy

    ▫ ERCP Therapeutic ▫ ▫ ▫
    ▫ Stent placement ▫ ▫ ▫
    ▫ Tumour Ablation ▫ ▫ ▫
    ▫ Endoscopic Ultrasound ▫ ▫ ▫
    ▫ Laser Endoscopy ▫ ▫ ▫
    ▫ Administration of Moderate Sedation ▫ ▫ ▫
    ▫ Others Please specify…………………………………………………...
    ………………………………………………………………………………..…….
    ▫ ▫ ▫
    ……………………………………………………………………………………..…

    Acknowledgement of Physician:

    I have requested only those privileges for which by education, training, current experience and demonstrated
    performance. I am qualified to perform and for which I wish to exercise at Moolchand Hospital and I understand
    that:

     In exercise any clinical privileges granted, I am constrained by Hospital rules and Physician guidelines
    applicable generally and any applicable to the particular situations.

     Any restrictions on the clinical privileges granted to me are waived in an emergency situation and in such
    situation my actions are governed by the applicable section of the Physician guidelines or related
    documents.

    Signed:…………………………………………………………………………………… Date:…………………
    (Applicant Signature)

    Signed:………………………………………………………………………………….
    (Departmental Coordinator)

    Signed: …………………………………………………………………………………
    (HOD Physician Relationship Team/ Medical Administrator)

    Signed: …………………………………………………………………………………
    (CEO/COO)

    Note: Copy at QMS server is controlled.


    Filename & path: /conversion/tmp/scratch/446157570.doc, Date: 11/10/2019

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