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Sample H&P privilege language There are a variety of viable ways to approach the delineation of medical history and physical exam (H&P) privileges. Following is a sampling of core privilege statements for various disciplines. Some address H&Ps in explicit terms, and others use alternative language. Podiatry H&P as it pertains to Podiatry, Excision-cutaneous lesions, Excision-nail- matrix, Excision-foreign body, Tenotomy & Capsulotomy of digits, Excision-tendon lesions (ganglion), Excision-inter-metatarsal neuroma, Excision-soft tissue lesion from rearfoot (ganglion), Plantar fascia release; Exostectomy of phalanx, Arthroplasty of toes, Tendon transfer or redirection in forefoot, Syndactylism of toes, Osteotomy of phalanges (with or without fixation), Bunionectomy (with or without osteotomy or implantation), Remodeling of lesser metatarsal (Plantar condylectomy, Tailor's bunion, Solitary metatarsal head resection), Sesamoidectomy, ProsthesisMPJ, Osteotomy of metatarsal (with or without fixation), Open repair of fracture-forefoot, Pan- Metatarsal head resection, Bunionectomy with osteotomy, Excision osseous tumor digit and forefoot, Skin Transfers/rotation flips, Partial ostectomy-lesser tarsus, Excision plantar calcaneal exostosis, Excision-retro-calcaneal exostosis spur, Fusion of metatarsal-cuneiform joint, Capsulotomy of midfoot, Amputation of ray. MUST CO-ADMIT WITH AN ACTIVE STAFF MEMBER. Source: Flagler Hospital Internal medicine Admission, diagnosis, treatment of the medical patient to include H&Ps. Includes ICU admission with appropriate consult. Includes privileges for Evaluation and Management, Supervision of TPN, Thrombolytic Therapy, interpretation of EKG, Holter Monitors, Simple Spirometry, Bone Marrow, Lumbar Puncture, Arterial Monitoring, Joint Aspiration, Endotracheal intubation, and Femoral Central Line placement, arterial lines without cutdown, paracentesis, thoracentesis, suturing of simple skin lacerations, removal of non-penetrating corneal foreign bodies, and minor strains and sprains, ventilator management, temporary transcutaneous pacemakers, and I&D of abscess, performance (not interpretation) of stress tests, and simple skin biopsy and removal. Source: Flagler Hospital Family medicine Admission of patients, medical history and physical examination, other diagnostic tests and therapeutic services, chart in the patient’s medical record, refer and request consultation. Source: Vicki Bond, CPMSM, ACHE, MHS General surgery Admit, evaluate, diagnose, consult, and provide pre, intra and post-operative care, and perform general surgical procedures, to pediatric (excluding newborn) and adult patients, except where specifically excluded from practice, to correct or treat various conditions, diseases, disorders and injuries of the alimentary tract, abdomen and its contents, extremities, breast, skin and soft tissue, head and neck, vascular and endocrine systems. Includes management of Level II trauma and care, stabilization and transfer out of critically ill patients with underlying surgical conditions from the emergency department, medicine, surgery and intensive care units. Source: Melinda E. Whitney, RN, BSN, BS, MS, CPHQ, CPMSM, FACHE Nurse practitioners (NP) in acute care Assess, diagnose, monitor, promote health and protection from disease, and manage patients within age group of collaborating/supervising physician. NPs [may/may not] admit patients to the hospital. They may provide care to patients in the intensive care setting in conformance with unit policies as well as assess, stabilize, and determine disposition of patients with emergent conditions consistent with medical staff policy regarding emergency and consultative call services. General core privileges include the procedures on the following procedure list and such other procedures that are extensions of the same techniques and skills. Perform history and physical Apply, remove, and change dressings and bandages Counsel and instruct patients, families, and caregivers as appropriate Debridement and general care for superficial wounds and minor superficial surgical procedures Dictate discharge summaries Direct care as specified by medical staff-approved protocols Implement therapeutic intervention for specific conditions when appropriate Implement palliative and end of life care through evaluation, modification, and documentation according to the patient’s response to therapy, changes in condition, and to therapeutic interventions to optimize patient outcomes. Initiate appropriate referrals Insert and remove nasogastric tube Make rounds on hospitalized patients Order and initial interpretation of diagnostic testing and therapeutic modalities such as laboratory tests, medications, hemodynamic monitoring, treatments, IV fluids and electrolytes, EMG, electrocardiogram, and radiologic examinations including arthrogram, ultrasound, CT, MRI, and bone scan studies, etc. Perform urinary bladder catheterization (short term and indwelling), e.g., Robinson, coudé, Foley Perform venous punctures for blood sampling, cultures, and IV catheterization Record progress notes Source: Core Privileges for AHPs: Develop and Implement Criteria-Based Privileging for Nonphysician Practitioners, Third Edition All privilege form excerpts were reprinted with permission.