Credential & Previlage Cathlab Nurse
Credential & Previlage Cathlab Nurse
Credential & Previlage Cathlab Nurse
Name: Date:
Applicant: In the first columns below, place a check in the appropriate box for each privilege
listed below.
A yes or no response must be entered for every item.
Chairperson: Place your initials in the appropriate column. An entry must be made for every item.
Directing, monitoring and evaluating the care delegated to non-
licensed personnel.
Performing assessments, developing a plan of care, implementing and
evaluating the care.
Responsible/accountable for management of the patient and provision
of care utilizing the nursing process, environment, instrumentation,
and other health care team members.
Under the direct supervision of the Director, Cardiac Cath Lab, the
Registered Nurse in the Cardiac Cath Lab is responsible for the
provision of safe and effective care of the patient having invasive or
non-invasive special procedures in the Cardiac Cath Lab to include the
immediate pre-procedure period, during the procedure, and
immediately following the procedure.
Must hold a current certificate in C.P.R and A.C.L.S
__________________________________ ____________
_______________
Signature of Applicant Regn. Number Code Number Date
RECOMMENDED BY:
______________________________________
MEDICAL SUPERINTENDENT
DATE:______________________
APPROVED BY:
___________________________________________________
Chairman, Credentialing & Privileging Committee
DATE:______________________