ClinCorePrivReqOB

8/13/2019 ClinCorePrivReqOB

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CLINICAL PRIVILEGE REQUEST

FOR FAMILY MEDICINE WITH MATERNITY CARE

Name:

Effective f!m ""#""#"" t! ""#""#""

INTRODUCTION OF CORE PRIVILEGES

Family medicine is the medical specialty which provides continuing, comprehensive

health care for the individual and family. It is a specialty in breadth that integrates the

biological, clinical and behavioral sciences. The scope of family medicine encompassesall ages, both sexes, each organ system and every disease entity.

Core privileges within the department of family medicine should reflect the corecurriculum and training offered in accredited family medicine residency programs. The

categories and core privileges listed are based on the Program e!uirements for

"raduate #edical $ducation in Family #edicine,% a publication by The &ccreditationCouncil for "raduate #edical $ducation '&C"#$(

'http)**www.acgme.org*ac+ebsite*downloads*Cproge!*-/pr0/1.pdf(, and the

ecommended Curriculum "uidelines for Family #edicine esidents% endorsed by the

&merican &cademy of Family Physicians 'http)**www.aafp.org*x-123.xml(. esourcesfor family physicians and hospitals for special non4core privileges can be found at the

&&FP website at aafp.org, including the &&FP position paper on colonoscopy found at

http)**www.aafp.org*online*en*home*policy*policies*c*colonoscopypositionpaper.html.

ELIGI$ILITY

To be eligible to apply for core privileges in family medicine, the applicant must meet the

following criteria)

Current certification or active participation in the examination process leading to

certification in family medicine by the &merican 5oard of Family #edicine or the

&merican 6steopathic 5oard of Family Physicians&nd*or

7uccessful completion of an &ccreditation Council for "raduate #edical

$ducation '&C"#$( or &merican 6steopathic &ssociation '&6&( accreditedpost4graduate training program in family medicine.

FAMILY MEDICINE CORE PRIVILEGES


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Re%&e'te( &dmission, evaluation, diagnosis, treatment and management of infants

and children, adolescents and adults for most illnesses, disorders and

in8uries. Core privileges include but are not limited to)

The care of neonates and infants, including both well4baby and ill

newborns.

Illnesses, disorders and in8uries of childhood, such as pneumonia,asthma, gastrointestinal infections, dehydration and urinary

tract infections.

Illnesses, disorders and in8uries of adolescence.

Illnesses, disorders and in8uries of the adult, including but not

limited to conditions of the heart, 9idney, lung,musculos9eletal system, s9in, eye, and nervous system, and

including multi4system diseases such as diabetes mellitus,

:I;*&I


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MATERNITY CORE PRIVILEGES

Re%&e'te( &dmit, evaluate and manage pregnancy, labor and delivery, post4partumcare, and other procedures related to maternity care, including medical

diseases that are complicating factors in pregnancy 'with consultation as

appropriate(. &pplicant must provide documentation of at least months

obstetrical rotation during family practice residency with 3/ patientsdelivered.

SPECIAL NON,CORE PRIVILEGES

To be eligible to apply for special non4core privileges, the applicant must havedocumented training and*or experience and current competence in performing the

re!uested procedure's( consistent with criteria set forth in medical staff policies

governing the exercise of specific privileges. This may be accomplished by providingdocumentation of acceptable supervised training and experience during residency and*or

fellowship training, or successful completion of an approved, recogni>ed course when

such exists.

C,Secti!+

Re%&e'te( Application Criteria: Successful completion of an ACGME or AOA

accredited residency training program in family medicine or obstetrics

and gynecology.Required Preious E!perience: A minimum of "# Cesarean birt$s as

primary operator.

Ac-+!.*e(/eme+t !f Pactiti!+e

I ac9nowledge that I have re!uested only those privileges for which by current

competence, training and*orexperience, I am !ualified to perform and for which I wish toexercise at the :ospital. I understand that I am bound by the applicable bylaws or policies

of the :ospital.


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Si/+e(: Date:

T01e( ! 1i+te( +ame:

De1atme+t C2ai3' Rec!mme+(ati!+

I have reviewed the re!uested clinical privileges and supporting documentation for theabove4named applicant and ma9e the following recommendation's()

Rec!mme+( a** e%&e'te( 1ivi*e/e'

Rec!mme+( 1ivi*e/e' .it2 t2e f!**!.i+/ c!+(iti!+'#m!(ificati!+':

D! +!t ec!mme+( t2e f!**!.i+/ e%&e'te( 1ivi*e/e':

Pivi*e/e C!+(iti!+#M!(ificati!+#E)1*a+ati!+

45

65

75

85

N!te':

De1atme+t C2ai Si/+at&e: Date:

FAMILY MEDICINE CORE: APPENDI9 A

CORE PROCEDURES

The following are a few examples of procedures from the Family #edicine C6$,

illustrating the depth of Family #edicine training. &s with other specialties, not every

applicant for privileges will choose to do all procedures within the core, and may elect to


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exclude those procedures from their privilege re!uest. It remains the responsibility of the

Family #edicine department chair to forward credentialing*privileging applications to

the credentials committee that have been appropriately vetted at the department level.

Ge+ea*

&rthrocentesis

Incision and drainage 'I ?


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Induction of labor

#anagement of uncomplicated labor

#anual removal of placenta, post delivery

6perative or assisted vaginal delivery

6xytocin challenge test

Post partum hemorrhage 'PP:(

Post partum endometritis

Pudendal anesthesia

epair of episiotomy, including lacerations*extensions

epair of vaginal and cervical lacerations

ing &ppendix & as a mechanism to restrict privileges for family physicians byinterpreting the appendix as a comprehensive delineation of services offered by family

physicians would be incorrect.

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