Medical Staff Delineation of Privileges

For the following privileges, separate documentation is required:

• C_Arm / Fluoroscopy Privileges
• Moderate (Conscious) Sedation Packet for Providers

Please select the form(s) that pertain to your department(s), print, complete, and send to:

Medical Staff Office
CWB, Room 204
750 East Adams Street
Syracuse, NY 13210
Fax (315) 464-8524

• Anesthesiology text
• Dental text
• Cardiopulmonary (Dept. of Surgery) text
• Cardiovascular Electrophysiology text
• Critical Care Medicine text
• Emergency Medicine text
• Endoscopy text
• Ophthalmology text
• Family Medical Practice text
• Obstetrics/ Gynecology text
• Internal Medicine text
• Neurosurgery text
• Neurology text
• Orthopedics text
• Otolaryngology text
• Pathology text
• Pediatrics text
• Peripheral Vascular Intervention (Addendum to Surgery, Radiology, & Invasive Cardiology Privileges forms) text
• Psychiatry text
• Physical Medicine and Rehabilitation text
• Plastic Surgery text
• General Surgery text
• Radiology text
• Radiation Oncology text
• Renal Dialysis text
• Urology text