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DELINEATION OF CLINICAL PRIVILEGES ORAL & MAXILLOFACIAL SURGERY 1. NAME OF PROVIDER (Last, First, MI) For use of this form, see AR 40-68; the proponent agency is OSG. 2. RANK/GRADE 3. FACILITY INSTRUCTIONS:
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The delineation of clinical privileges is the process by which healthcare providers are granted the ability to perform specific medical procedures or provide specific medical services within a healthcare facility.
All healthcare providers who wish to perform medical procedures or provide medical services within a healthcare facility are required to file delineation of clinical privileges.
Healthcare providers must fill out a delineation of clinical privileges form provided by the healthcare facility, listing their qualifications, training, and experience for each specific procedure or service they wish to perform.
The purpose of delineation of clinical privileges is to ensure that healthcare providers are qualified and competent to perform specific medical procedures or provide specific medical services, in order to ensure patient safety and quality of care.
Healthcare providers must report their qualifications, training, experience, and any relevant certifications or licenses for each specific procedure or service they wish to perform.
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