Privileging - Obstetrician, Gynecologist, Nurse Practitioner, Mid-Wife
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Check the boxes next to the privileges you seek.
History and physical exam
Prenatal care
Threatened abortion
Pyelonephritis and other UTI's in pregnancy
Well-woman exams
Diagnosis and treatment of STDs
Contraceptive management
Basic life support
Automated external defibrillator
Pap smears
Colposcopy
Endometrial biopsy
Vaginal diaphragm fitting
Intrauterine device insertion/removal
Cervical biopsy
Breast mass aspiration
Drainage of skin abcess
Biopsy of skin lesion
Removal of skin tags
I&D of vulva/perineum
I&D of gland abscess
Biopsy of vulva/perineum/vagina/cervix
Fetal non-stress test
Antepartum care
OB/GYN Ultrasound
Neonatal Resuscitation (NRP)
Nexplanon insertion/removal
Wet Prep
KOH
Condyloma removal TCA
Primary Care
Pessary
Diabetes in pregnancy
HTN in pregnancy
Cervical Cerclage
Cryo
Urodynamics
IUI
Thyroid management in pregnancy
Prescription of Schedule III-V substances
Prescription of Schedule II substances
Medical translation (enter language)
Any additional privileges not listed here?
Concerns/comments:
I attest that I have appropriate training, competence, experience, and comfort level for each privilege requested.
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