Pathology Privileges
Group 7
7.00 Pathology Core Privileges
Qualifications - to be eligible to apply for core privileges in pathology, the applicant must meet the following qualifications:
Demonstration of the provision of pathology services during the past 24 months;
And
Current certification or active participation in the examination process leading to certification in clinical and/or anatomic pathology by the American Board of Pathology or the American Osteopathic Board of Pathology (if required by contract or hospital policy); or
Successful completion of an ACGME- or AOA-accredited residency in clinical and anatomicpathology or a subspecialty of pathology.
7.01Anatomic Core Privileges - Examination of body tissue or organs, including: general anatomical, autopsy, cytopathology, and surgical pathology.
☐Requested / ☐Recommended / ☐ Not Recommended☐ Recommended with the following modification(s) and reason(s):
Please click here to enter recommended modifications and reasons.
7.02Clinical Core Privileges - Examination of blood, urine and other body fluids to determine the status of patients and to help in the diagnosis of diseases, including: microbiology, clinical chemistry, immunology, blood banking, coagulation, and hematology.
☐Requested / ☐Recommended / ☐ Not Recommended☐ Recommended with the following modification(s) and reason(s):
Please click here to enter recommended modifications and reasons.
7.03Special Procedures Privileges (see qualifications and/or specific criteria listed on page 2 and 3)
To be eligible to apply for a special procedure privilege listed below, the applicant must demonstrate successful completion of an approved and recognized course or acceptable supervised training in residency, fellowship, or other acceptable experience; and provide documentation of competence in performing that procedure consistent with the criteria set forth in the medical staff policies governing the exercise of specific privileges.
Procedure / Criteria / Requested / Recommended / Not RecommendedBone marrow aspiration/biopsy / Initial application: Successful performance of 6 procedures in past 12 months
Continued competence: Successful performance of 12 procedures in past 24 months
Or
Demonstration of competence under the supervision of a qualified member of the medical staff / ☐ / ☐ / ☐ /
Fine needle aspiration of superficial masses (not under CT guidance) / Initial application: Successful performance of 6 procedures in past 12 months
Continued competence: Successful performance of 12 procedures in past 24 months
Or
Demonstration of competence under the supervision of a qualified member of the medical staff / ☐ / ☐ / ☐ /
☐ Recommended with the following modification(s) and reason(s):
Please click here to enter recommended modifications and reasons.
Forensic Pathology – investigate and evaluate cases of sudden, unexpected, suspicious, and violent death as well as other specific classes of death defined by law, including performing medico-legal autopsies. This privilege includes bedside evaluation/consultation of an injured or abused medico-legal patient as required by law or in the judgment of law enforcement or attending/consulting physician.
(Requirements – successful completion of postgraduate training that included training in forensic pathology and/or subspecialty certification in forensic pathology. At Hurley Medical Center, an individual applying for this privilege is limited to the individual employed by or contracted with the Genesee County Health Department and Genesee County Board of Commissioners.)
☐Requested / ☐Recommended / ☐ Not Recommended☐ Recommended with the following modification(s) and reason(s):
Please click here to enter recommended modifications and reasons.
Acknowledgement of Practitioner
I have requested only those privileges for which by education, training, current experience, and
demonstrated performance I am qualified to perform, and that I wish to exercise at Hurley Medical Center, and I understand that: (a) In exercising any clinical privileges granted, I am constrained by hospital and medical staff policies and rules applicable generally and any applicable to the particular situation. (b) Any restriction on the clinical privileges granted to me is waived in an emergency situation and in such a situation my actions are governed by the applicable section of the medical staff bylaws or related documents.
Signed: ______Date______
Department Chair’s Recommendation
I have reviewed the requested clinical privileges and supportive documentation for the above named applicant and recommend action on the privileges as noted above.
Signed: ______Date______
Credentials Committee Approval Date______
Executive Committee Approval Date______
Board Approval Date______
Pathology Core PrivilegesPage 1 of 3 rev 09/07