This document defines the clinical privileges and scope of practice for a neurologist. It provides instructions for the applicant and clinical supervisor to request, verify, and recommend approval of specific clinical privileges. The applicant is to select a code of 1, 2, or 4 to indicate their current ability for each requested privilege. The clinical supervisor will then verify each requested privilege and recommend its approval, approval with modification, or disapproval. Specific clinical privileges listed for a neurologist include electroencephalograms, nerve biopsies, nerve conduction studies, and lumbar punctures.
This document defines the clinical privileges and scope of practice for a neurologist. It provides instructions for the applicant and clinical supervisor to request, verify, and recommend approval of specific clinical privileges. The applicant is to select a code of 1, 2, or 4 to indicate their current ability for each requested privilege. The clinical supervisor will then verify each requested privilege and recommend its approval, approval with modification, or disapproval. Specific clinical privileges listed for a neurologist include electroencephalograms, nerve biopsies, nerve conduction studies, and lumbar punctures.
This document defines the clinical privileges and scope of practice for a neurologist. It provides instructions for the applicant and clinical supervisor to request, verify, and recommend approval of specific clinical privileges. The applicant is to select a code of 1, 2, or 4 to indicate their current ability for each requested privilege. The clinical supervisor will then verify each requested privilege and recommend its approval, approval with modification, or disapproval. Specific clinical privileges listed for a neurologist include electroencephalograms, nerve biopsies, nerve conduction studies, and lumbar punctures.
This document defines the clinical privileges and scope of practice for a neurologist. It provides instructions for the applicant and clinical supervisor to request, verify, and recommend approval of specific clinical privileges. The applicant is to select a code of 1, 2, or 4 to indicate their current ability for each requested privilege. The clinical supervisor will then verify each requested privilege and recommend its approval, approval with modification, or disapproval. Specific clinical privileges listed for a neurologist include electroencephalograms, nerve biopsies, nerve conduction studies, and lumbar punctures.
AUTHORITY: Title 10, U.S.C. Chapter 55, Sections 1094 an 110!.
"RI#CI"A$ "UR"OS%: To e&ne the scope an li'its o( practice (or ini)i*al pro)iers. "ri)ile+es are ,ase on e)al*ation o( the ini)i*al-s creentials an per(or'ance. ROUTI#% US%: In(or'ation on this (or' 'a. ,e release to +o)ern'ent ,oars or a+encies, or to pro(essional societies or or+ani/ations, i( neee to license or 'onitor pro(essional stanars o( health care pro)iers. It 'a. also ,e release to ci)ilian 'eical instit*tions or or+ani/ations 0here the pro)ier is appl.in+ (or sta1 pri)ile+es INSTRUCTIONS APPLICANT: In Part I, enter Code 1, 2, or 4 in each REQUESTED block for every rivile!e li"ted# Thi" i" to reflect c$rrent caability and "ho$ld not con"ider any kno%n facility li&itation"# Si!n and date the for&# 'or%ard the for& to yo$r Clinical S$ervi"or# (Make all entries in ink.) CLINICAL SUPERVISOR: In Part I, $"in! the facility &a"ter rivile!e" li"t, enter Code 1, 2, (, or 4 in each )ERI'IED block in an"%er to each re*$e"ted rivile!e# In Part II, check aroriate block either to reco&&end aroval, to reco&&end aroval %ith &odification, or to reco&&end di"aroval# Si!n and date the for&# 'or%ard the for& to the Credential" '$nction# (Make all entries in ink.) CODES: 1. Fully competent !t"!n #e$!ne# %cope o$ p&'ct!ce. (Clinical oversight of some allied health providers is required as defined in AFI 44-119.) (. Supe&)!%!on &e*u!&e#. (nlicensed!uncertified or lac"s current relevant clinical e#perience.) +. Not 'pp&o)e# #ue to l'c, o$ $'c!l!ty %uppo&t. ($eference facilit% master privileges list.) -. Not &e*ue%te#.not 'pp&o)e# #ue to l'c, o$ e/pe&t!%e o& p&o$!c!ency0 o& #ue to p"y%!c'l #!%'1!l!ty o& l!m!t't!on. C2ANGES: +ny chan!e to a verified,aroved rivile!e" li"t &$"t be &ade in accordance %ith +'I 44-11.# NA3E OF APPLICANT (&ast' First' (iddle Initial)
NA3E OF 3EDICAL FACILIT4
I. LIST OF CLINICAL PRIVILEGES NEUROLOGIST Re*$e"ted )erified Re*$e"ted )erified A. Elect&oencep"'lo5&'m I. Pe&!p"e&'l ne&)e 1loc,% 6. E)o,e# potent!'l% 7. C'&ot!# #uple/ ult&'%ono5&'p"y C. Elect&omyo5&'p"y 8. T&'n%c&'n!'l #opple& D. Ne&)e con#uct!on )eloc!t!e% L. C"emo#ene&)'t!on E. Lum1'& punctu&e 3. Ot"e& ()pecif%) F. Lum1'& punctu&e !t" $luo&o%copy 1. G. 3u%cle 1!op%y (. 2. Ne&)e 1!op%y +. SIGNATURE OF APPLICANT DATE