Medical Staff Policies and Procedures


24 Hour Study And Esophageal Manometry Interpretation Privilege Criteria
Accepting Orders for Hospital Outpatent Services from Non-Priv Providers
Access to Credentials Peer Review File
Allied Health Competencies
Ankle Fracture Open Repair
Application Fees on Initial Application
Appointment-Allied Health Professionals
Artificial Disc Implant
Atrial Septal Defect (ASD) Closure Patent Foramen Ovale (PFO) In Adults
Autopsies Criteria
Balloon Aortic Valvuloplasty
Balloon Kyphoplasty
Bariatric Surgery Privilege Criteria
Behavioral Health Assessment Clinicians Credentialing Criteria
Board Certification Assessment
Bronchial Thermoplasty
Call Coverage for Credentialed Medical Staff
Cardiac Catheterization Diagnostic
Cardiac CT-CTA Privilege Criteria
Cardiac Resuscitation Competence
Cardiothoracic and General Thoracic Privilege
Cardiovascular Dept CVS and PVS Peer Review and Attendance
Carotid Stent Placement andor Angioplasty Privilege Criteria
Certified Registered Nurse Anesthetist (CRNA)
Chest Tube Insertion
Circumcision for Neonatal Privilege Criteria
Clinical Observations Process
Cochlear Implantation Privilege Criteria
Competency Assessment When Case Volumes Not Met
Computerized Physician Order Entry (CPOE)
Conflict of Interest
Consent for Treatment of Pregnant Minor Policy & Flowchart
Continuing Medical Education Requirements
Continuous Care and Supervision of Patients
Core Privileging
Credentials Corrective Action File
Criminal Checks on Initial Application
Criteria for Waiver for Age Exception of 75
Criteria for Waiver From ERS Call
Critically Ill Patient Who is Unstable
Cryo Catheter Ablation
DaVinci Robotic Assisted Surgery
Developing Criteria for Privileges
Disaster Criteria for Credentialing Physicians & Allied Health
Drug Enforcement Administration Expiration Certificate Or Indiana (CSR)
Dues Policy and Procedure
Elective (non-emergent) Percutaneous Tracheostomy Cricothyrothomy Tube Placement 
Emergency Department Ultrasound Criteria
Emergency Service (ERS) Call - Plymouth
Emergency Service (ERS) Call & Emergency Medical Treatment & Labor Act (EMTALA) 
Emergency Service (ERS) Call Policy and Procedure
Endobronchial Balloon Dilation
Endobronchial Stent Placement
Endograft Repair for Abdominal Aortic Aneurysm (AAA)
Endograft Repair for Thoracic Aortic Aneurysm (TAA)
Endomyocardial Biopsy (Closed)
Endoscopic Ultrasound (includes Cysts Drainage Stents)
Endovenous (Superficial And Deep) Privilege Criteria
Epicardial VT Ablation Pol
Epidural Interventional Lumbar Injections Privilege Criteria
Family Med & Internal Med Outpatient Follow-up Call Schedule
Flu Vaccination Pol
Flu Vaccination
Focused Aspiration Of Scar Tissue (Fast) Procedure
Focused Professional Practice Evaluation (FPPE)
Gastrointestinal Endoscopy (Upper) and Colonoscopy Privilege Criteria
Glaucoma Operations-Trabeculectomy
Globus –ExcelsiusGPS Robotic Navigation for Spine Surgery
Hand-Off Communication
History & Physical for Podiatrists for ASA Class 1 & 2 Patients
History & Physical Medical Staff Policy - Plym
History and Physical Medical Staff
Holding Orders - Patients admitted through the Emergency Department
Hospitalist and Community Provider Service Agreement Medical Staff Policy & Form
Hyperbaric Oxygen Therapy for Wound Healing
Impaired or Dysfunctional Physician Policy
Impella Privilege Criteria Policy
Informed Consent Policy
Informed Consent
Intra-Operative Arrhythmia Surgery
Joint Medical Staff Peer Review Committees
Joint Replacement of the Elbow
Joint Replacement of the Hand, Thumb and Small Joint

Laboratory Physician Performed Testing
Lameller Kerotoplasty
Lead Extractions With or Without Laser
Leadless Pacemaker Regional Implant Criteria
Left Atrial Appendage Closure Device Transseptal (Watchman) Privilege Criteria
Limited CT Scan for Calcium Scoring and Coronary Artery Anatomy in Rapid Scan Privilege Criteria
MAKO-Robotic Assisted Orthopedic Procedures
Malpractice Guidelines for Credentialing Practitioners
Malpractice Insurance Acceptable Coverage
Medical Directors
Medical Records Completion
Medical Staff Application Fees (Initial and Reappointment)
Medical Staff Funds Source, Annual Donations & Compensation
Medical Staff Mission Statement and Code Of Conduct
Medical Staff Peer Review
Medical Staff Proctoring
Medical Staff Professional Performance Council
Monitoring Medicare Attestation Statements
New Techniques Enhancement of Procedures
Non-Epidural Interventional Injections Privilege Criteria
Nuclear Cardiology
Nurse Practitioner and Physician Assistant Patient Rounding for Consultant Privilege Criteria
Nurse Practitioner and Physician Assistant Patient Rounding Privilege Criteria
Obstetric Privilege Criteria
Occurrence Monitoring & Peer Review (Medical Staff)
Ongoing Professional Practice Evaluation  - Plymouth
Ongoing Professional Practice Evaluation
Osteopathic Physician Privilege
Palliative Medicine (non-procedural)
Patient Privacy and Confidentiality Policy and Procedure
Penetrating Keratoplasty
Percutaneous Vertebroplasty Privilege
Peripheral Vascular Privilege Criteria Peripheral Vascular Privilege Criteria
Permanent Implantation of Electric Dorsal Column Stimulators and Infusion Pumps
Permanent Pacemakers Insertion-Single Dual Chamber Non-Resynchronization Device
Photography, Videography, and Audio Recording for Clinical Research and Educational
Photography, Videography, and Audio Recording for Clinical Research and Educational
Physician Assistant Central Line & Chest Tube Placement
Physician Competency for Sedation
Physician Dismissal by Patient
Placement of External Radiotherapeutic Source
Podiatrists and Wound Care
Practitioner Participation in the Peer Review Process
Proctoring Policy and Procedure (Medical Staff)
Prostate Cryoablation
Prostatic Radioactive Seed Implanting Privilege Criteria
Psychiatric Medical Assistant Credentialing Criteria
Requests For Reports Or Data Policy And Procedure
Requirements for Physician Reappointment for CME
Residents (Performance of Procedures by Outside Residents)
Residents and Medical Students Supervision
Retinal Detachment Surgery
Sacral Nerve Stimulator for Urinary Control
Saint Joseph Health System Agreement for the Coordination of Patient Care
Sedation (Moderate & Deep) Performed by Non-Anesthesiologists
Sedation Performed by Non-Anesthesia Provider Hospital Policy
SJHS Plymouth Medical Staff Dues Policy & Procedure
SJHS Plymouth Medical Staff Funds Source, Annual Donations & Compensation
Sleep Studies Interpretation Privilege Criteria
Stress Test Privilege Criteria
Stroke Education for Code Stroke
Surgery Committee Scope and Functions
Surgical Assisting By A Physician
TB Testing – Medical Staff
Temporary Privileges Credentialing
Tissues Exempted from Pathological Exam
Total Ankle Privilege Criteria
Total Ankle Replacement
Transcarotid Artery Revascularization (TCAR) Privilege Criteria
Transcatheter Aortic Valve Replacement (TAVR) Privilege Criteria
Transesophageal Echocardiography (TEE) & (TTE)
Transilluminated Powered Phlebectomy
Transoral Incisionless Fundoplication Procedure (TIF)
Trauma Victim Care- Captaincy
Unattached Patients Requiring Primary Care Follow Up
Vagus Nerve Stimulator Implantation Privilege Criteria
Vascular Privileges Including Carotid, Aortic and Peripheral
Well Being Committee-Centralized