COVID-19 FORMS

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

Handbook

• New Provider Handbook

Practitioner Data Review

• Practitioner Data Review form

How to review data in Tableau

• How to review data (written instructions)

Clinical Department Forms

• 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

Other Forms

• Provider Education Request Form
• Procedure Tracking form
• Robotics Procedure Tracking form
• ECT Review form
• Application Fee 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)