Title VI Education

• Title VI Education
  • This video takes approximately 30 minutes.  Do not answer the questions embedded in the video, or enter your name and personal information at the end of the video.  Instead, please complete the following SurveyMonkey to document your completion of this education.
  • SurveyMonkey education completion

Handbook

• New Provider Handbook

Clinical Department Forms

• Request to send Medical Staff application
• Urgent Processing Request form
• Increase in Privileges Request
• Proctoring documentation and Case log tracking
• Locum Tenens Evaluation
• Notify of Resignation/Termination
• Surgical Case Review (optional form)
• Record of Complaint Form

Practitioner Data Review

• Practitioner Data Review form
• How to review data (written instructions)

How to review data in Tableau

COVID-19 Forms

• Volunteer application: Upstate University Hospital
• SCHC Release and Employer Attestation

Other Forms

• Provider Education Request Form
• Procedure Tracking form
• Robotics Procedure Tracking form
• ECT Review form
• Application Fee Invoice - please contact your coordinator for an invoice

Other Applications

• Visiting Health Care Provider (Observer only)
• Visiting Health Care Provider (with privileges)
• Health Professional Shadowing / Precepting packet (Not for SUNY Upstate NP and PA students)