2100 Nw 63rd St., L.L.C
2100 Northwest 63rd St.
Oklahoma City, OK 73116
(405)-842-6677
Credentialing Criteria for Visiting Physicians
COSMETIC SURGERY PRIVILEGE DELINEATION
We are very proud and honored that so many physicians from throughout the world have chosen to visit our facility. We thank each of you for making our lives more complete. Our mutual goal is improved patient safety and consistency of surgical results and we feel proud to be on the forefront of educating the world in improved techniques and patient care.
We do have some preliminary requests prior to scheduling time with our facility.
1. We ask that you contact our front office for information and scheduling. We do not want more than one physician at a time in order to improve the experience and decrease frustration.
2. We ask that you fax a current and complete resume and a copy of an unrestricted medical license to our office manager at (405) 842-6678. Please confirm that we have received this prior to your arrival. This is mandated by our state, the AAAHC accreditation service and our facility insurance.
3. We have a list of varying quality hotels locally we can suggest. Always inform them when calling that you will be with Nuveen Cosmetic Surgery and they will have reduced rates for you or ask for a room upgrade to a suite if possible for a minimal charge.
4. I ask for only one thing in return. Be eager, enthusiastic and open to new ideas.
5. The burden of education falls primarily on the staff and we are very busy already. The staff is always appreciative of a free lunch of two during your stay as a gesture of good will. They can be bought!
In order to be eligible to request clinical privileges for both initial appointment, a practitioner must meet the following minimum threshold criteria:
Education: M.D.; D.O. and/or D.D.S./ D.M.D.
Formal Training: The applicant must demonstrate successful completion of a postgraduate residency program approved by the ACGME or the AOA in:
1. Plastic Surgery;
2. General Surgery;
3. Otolaryngology (Head and Neck);
4. Ophthalmology, with Oculoplastic Fellowship or Board Certified Ocular Plastic Diplomat, with one-year General Surgery Training;
5. Oral/Maxillofacial Surgery, with dual MD and DDS Degree and one-year General Surgery Training;
6. Dermatology, with one-year general surgery training; and/or
7. Gynecology
OR
Board Certification by the American Board of Cosmetic Surgery
Required Clinical Experience: The applicant must be able to demonstrate that he/she has satisfactorily performed as the primary/operating surgeon within the scope of services outlined in the privileges listed and checked below.
The JCAHO, AMA, Medicare and the AAAHC specifies four core criteria that should be met when credentialing licensed independent practitioners, including current licensure, relevant training or experience, current competence (defined as letters from authoritative sources attesting to the applicant’s scope and level of performance), and the ability to perform privileges requested.
The facility will ensure that the initial Credentialing process obtains and verifies the following information:
A. A current valid license, registration or certificate to practice, a valid Drug Enforcement Agency registration number as applicable.
B. Graduation from a medical school, completion of a residency, Board certified or Board eligible as applicable; education as required.
C. Clinical privileges in good standing at a hospital designated by the practitioner.
D. Work history.
E. Professional liability claims history.
F. Requested information from: National Practitioner Data Bank and the Medical Board of Oklahoma.
G. Any sanctions imposed by Medicare and Medicaid.
H. A signed statement by the practitioner at time of application regarding any physical or mental health problems.
DISCRIMINATION
The fundamental criteria for medical staff membership or clinical privileges should be directly related to the delivery of quality medical care, professional ability and judgment, and community need. Medical staff membership or particular clinical privileges should not be denied on the basis of gender, color, creed, race, religion, age, ethnic or national origin, political beliefs, disability, socioeconomic status, or sexual orientation.
We now require that all visiting physicians complete the application and send three letters of reference using the form below.
Professional Reference Questionnaire.
The above noted practitioner has applied to the medical staff at one or more affiliated inpatient hospitals/outpatient surgery centers or office facilities. You've been listed as a professional reference. Please answer all questions based on your knowledge and direct observation of the candidate. Your candid reply will be appreciated, and your answers will be confidential, except as is necessary for composting the credentialing process, war for any related due process procedures. A signed consent for release is provided.
This Reference provided by:
Your specialty:
1. Years you have known applicant:
2. Dates that you have had the opportunity to directly observe the applicant in the practice of surgery:
3. In what setting did you observe the applicant? Please circle the following:
Hospital surgery center office setting elsewhere
And what time, what was your position or title?
What was the applicant's position or title?
4. Were you, are you now, or are you about to become related to the applicant, as family, or through a professional partnership or financial association?
PLEASE CLASSIFY: Superlative Very good Good Fair Poor N/A
5. Medical knowledge. S VG G F P N/A
6. Technical and clinical skills. S VG G F P N/A
7. Thoroughness in patient care S VG G F P N/A
8. Have you ever observed, or been informed of any physical, mental health, drug or alcohol dependency, or other problems which the applicant has had, or could potentially impair the ability to exercise clinical privileges requested?
9. Please add any comments relevant to the applicant's medical knowledge, competence, demonstrated skill and abilities. Are there any clinical areas, procedures, or patient severity levels for which you are concerned about the applicant's ability?
10. Please indicate and explain any reservations, concerns or recommendations concerning specific privileges requested by the applicant.
11. To your knowledge, has the applicant's license, clinical privileges, hospital staff membership, or other professional status ever been denied, challenged, suspended, revoked, modified, or voluntarily surrendered?
12. To your knowledge, has the applicant ever been a defendant a medical malpractice action?
13. Please rate the following:
Superlative(S) Very good(VG) Good(G) Fair(F) Poor(P) N/A
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Please comment on skills and areas where you believe the applicant has particular talent. Provide any additional comments, information recommendations, you believe would be relevant to a decision in granting membership or clinical privileges:
Signed: Date: