BUMEDINST6320.66E

29 Aug 2006

DEPARTMENT OF THE NAVY

PEDIATRICS - CORE PRIVILEGES

Comprehensive examination, consultation, diagnosis, management and treatment of conditions in neonates, infants, preschool-age and school-age children and adolescents to include:

*Attendance at routine or high-risk delivery to provide care, evaluation, resuscitation

and stabilization of the neonate

*Routine premature and neonatal care, including management of neonatal sepsis,

hyperbilirubinemia, uncomplicated respiratory distress syndrome, endotracheal

intubation and vascular access

*Health supervision of infants, children and adolescents with appropriate anticipatory

guidance, preventive (e.g., immunizations) and screening measures

*Minor surgical diagnostic procedures, including transfusion of blood products,

venous cutdowns, spinal taps, incision and drainage of abscesses, suture of simple

lacerations and circumcisions

*Acute and chronic conditions

*Preoperative and postoperative care

*Unique or life-threatening pediatric concerns to include child abuse and neglect,

poisoning and accidents and upper airway obstruction

*Counseling regarding developmental disabilities, e.g., cerebral palsy, mental

retardation, birth defects, emotional disorders and adjustment reactions of children

and adolescents

*Instruction of other health care professionals seeing children, e.g., neonatal

resuscitation and pediatric advanced life support

PEDIATRICS - SUPPLEMENTAL PRIVILEGES

Check “Yes” or “No” by each supplemental privilege

Dept Head Initial / “Yes or No” / Supplemental Privileges
Management of tertiary neonatal care to include hyper-alimentation, complex respiratory, and ventilatory care
Management of complex adolescent conditions, including growth andmaturational disorders, gynecological and obstetrical conditions, severe behavioral disturbances and substance abuse
Complex physically or developmentally disabled children, including coordinating multiple services and disciplines in an organized treatment plan, developmental testing for interpretation, management of severe childhood behavioralproblems and genetic counseling
Complex, life-threatening allergic and immunologic diseases, including severe immune deficiency, skin testing and hyposensitization therapy
Complex, life-threatening heart disease, including severe heart disease of the neonate, interpretation of echocardiograms, angiography and cardiac catheterization

Provider:______Date: ______

PEDIATRICS - SUPPLEMENTAL PRIVILEGES (continued)

Check “Yes” or “No” by each supplemental privilege

Dept Head Initial / “Yes or No” / Supplemental Privileges
Childhood malignancies and complex hematologic disorders including chemotherapeutic agents, bone marrow biopsies and smears, bone marrow failure syndrome and life-threatening coagulopathies
Complex renal disorders, including end stage renal disease, renal biopsy andinterpretation, peritoneal dialysis and hemodialysis
Acute and chronic complex neurologic disorders including interpretation of EEGs, cranial ultrasound, computer-assisted tomography, magnetic resonance imaging scans, interpretation of electromyography, and muscle and nerve tissue biopsy
Simple and complex endocrinologic disorders
Life-threatening infectious diseases
Severe gastrointestinal and nutritional disorders, including endoscopy, hepatic biopsy and interpretation, and intestinal biopsy and interpretation
N/A / N/A / Conscious sedation ** Facility Not Support**

Other:

Dept Head Initial / “Yes or No” / Supplemental Privileges
Complex Rhumatological Immunological and Allergic diseases, to include Arthrocentesis(completion of ACGME accredited training in particular fellowship)
Adolescent/Pediatric Management of Respiratory/ Pulmonary Disease; Respiratory Distress acute & chronic (including respiratory failure); Flexible bronchs with Broncho Alvealor Lavage (BAL); PFT interpretation; Chest x-ray/chest CT interpretation; Ventilator management; Adult Cystic Fibrosis. Completion of ACGME accredited training in particular fellowship, board eligible or board certified

Note: Department Heads are responsible for ensuring that any changes to a provider’s request by the department head must accompany an explanation. In addition to, informing the member of the change.

By signing below, it is the assumption of Professional Affairs that the department head as the subject matter expert has notified the member of any changes or is in agreement to the request being made.

Facility: National Naval MedicalCenter, BethesdaMd Date Approved:______

Provider: ______Date: ______

Dept Head: ______Date: ______

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Revised solely for the use by the National Naval Medical Center Bethesda, MD