{"id":534,"date":"2020-07-09T10:00:28","date_gmt":"2020-07-09T10:00:28","guid":{"rendered":"https:\/\/dhs.lacounty.gov\/lageneral\/if-you-have-reached-this-point-you-have-completed-your-reappointment-packet-a-submit-your-packet-to-the-attending-staff-office\/"},"modified":"2023-04-24T12:42:50","modified_gmt":"2023-04-24T19:42:50","slug":"physician-reappointment-forms","status":"publish","type":"page","link":"https:\/\/dhs.lacounty.gov\/lageneral\/who-we-are\/attending-staff\/credentialing-applications\/physician-reappointment-forms\/","title":{"rendered":"Physician – Reappointment Forms"},"content":{"rendered":"

[vc_row][vc_column][vc_column_text]<\/p>\n

    \n
  1. Read First. \u00a0Please utilize the included checklist to ensure that you are returning all of the required documents: Reappointment Cover Page<\/a><\/li>\n
  2. Read and Complete: Reappointment Form<\/a><\/li>\n
  3. Forward letter to your peers or have the ASO distribute them: Peer Reference Letter<\/a><\/li>\n
  4. Read and sign:
    \na. \u00a0    EMTALA Regulations Statement<\/a>
    \n\u21d2\u00a0    Read the EMTALA Reference Guide<\/a>
    \nb. \u00a0    List of Hospital Affiliations<\/a>
    \nc. \u00a0    Tuberculosis Screening<\/a>
    \nd. \u00a0    Data Security Acknowledgment Statement<\/a>
    \n\u21d2\u00a0    Read the Data Security Policy<\/a><\/li>\n
  5. Complete the HIPAA Security Training Program. Please read: HIPAA Self Study Guide<\/a><\/li>\n
  6. Select your Privilege Form. \u00a0Please note: \u00a0When requesting privileges for more than one department, you need to fill out one application only.
    \n    Anesthesiology<\/a>
    \n    Dentistry<\/a>
    \n    Dermatology<\/a>
    \n    Emergency Medicine<\/a>
    \n    Employee Health\/Occupational Medicine<\/a>
    \n    Family Medicine<\/a>
    \n    Medical Education<\/a>
    \n    Medicine for Comprehensive Health Centers<\/a>
    \n    Medicine for LA General Medical Center<\/a>
    \n    Neurology<\/a>
    \n    Neurosurgery<\/a>
    \n    Obstetrics and Gynecology<\/a>
    \n    Obstetrics and Gynecology (Office Practice Procedures)<\/a>
    \n    Ophthalmology<\/a>
    \n    Orthopedics<\/a>
    \n    Otolaryngology<\/a>
    \n    Pathology<\/a>
    \n    Pediatrics<\/a>
    \n    Pharmacist for Hepatitis-C Clinic<\/a>
    \n    Podiatry<\/a>
    \n    Psychiatry<\/a>
    \n    Radiation Oncology<\/a>
    \n    Radiology<\/a>
    \n    Surgery<\/a>
    \n    Urology<\/a><\/li>\n
  7. For Moderate Sedation Privileges (if applicable):
    \nPlease read:     Moderate Sedation Learning Module<\/a>
    \n    Moderate Sedation Policy<\/a>
    \nComplete and submit:     Moderate Sedation Request Form<\/a>
    \n    Moderate Sedation Request Exam<\/a>
    \n    Moderate Sedation Request Answer Sheet<\/a><\/li>\n
  8. For Brain Death Privileges (if applicable):
    \nPlease read:     Brain Death Syllabus<\/a>
    \n    Brain Death Policy and Procedure<\/a>
    \n    Brain Death Declaration Form Checklist<\/a>
    \nComplete and submit:     Brain Death Request Form<\/a>
    \n    Brain Death Exam<\/a>
    \n    Brain Death Answer Sheet<\/a><\/li>\n
  9. For Patient Controlled Analgesia Privileges (if applicable):
    \nPlease read:     Patient Controlled Analgesia<\/a>
    \nComplete and submit:     Patient Controlled Analgesia Exam<\/a><\/li>\n<\/ol>\n

    IF YOU HAVE REACHED THIS POINT, YOU HAVE COMPLETED YOUR REAPPOINTMENT PACKET. \u00a0Submit your packet to the Attending Staff Office:<\/strong><\/p>\n

    Attending Staff Office
    \n1200 N. State St.
    \nClinic Tower, Room 2B300
    \nLos Angeles, CA 90033[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"

    [vc_row][vc_column][vc_column_text] Read First. \u00a0Please utilize the included checklist to ensure that you are returning all of the required documents: Reappointment Cover Page Read and Complete: Reappointment Form Forward letter to your peers or have the ASO distribute them: Peer Reference Letter Read and sign: a. \u00a0EMTALA Regulations Statement \u21d2\u00a0Read the EMTALA Reference Guide b. \u00a0List […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":300,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-templates\/template-subsite-basic-page.php","meta":{"_oasis_is_in_workflow":0,"_oasis_original":0,"_monsterinsights_skip_tracking":false,"footnotes":"","_links_to":"","_links_to_target":""},"categories":[1],"tags":[],"class_list":["post-534","page","type-page","status-publish","hentry","category-uncategorized"],"yoast_head":"\nPhysician - Reappointment Forms - LA General Medical Center<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/dhs.lacounty.gov\/lageneral\/who-we-are\/attending-staff\/credentialing-applications\/physician-reappointment-forms\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Physician - 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