Blessing Hospital Procedure Privileging Form

Blessing Hospital Procedure Privileging Form

All fields are required.

Patient Medical Record #
Resident Physician:
Supervising Physician:
Date:
Procedure	Thoracentesis Paracentesis Percutaneous central venous catheter Lumbar puncture Chest tube placement
I attest that the above procedure was performed safely and appropriately:
Supervising Attending:

Family Practice Resident & Fellows Physician Procedure Privileging Policy .pdf