Clinical Privileges for Resident

Doctors

Name of the doctor………………………………………………………………………………

Speciality: …………………………………………………………………………………………….
Initial Appointment

Reappointment

Qualifications: Successful completion of MD/MS/DNB/Diploma in relevant speciality or equivalent degree from

Medical Council of India recognized University and Hospital.

Required Previous Experience: Non applicable

Special Procedures: Non applicable

Reappointment/Requirements: Non applicable

Applicant: Place a check mark in the (R) column for each privilege requested.

(R) =Requested (A) =Recommended as Requested (C) =Recommended with Condition (N) =Not
Recommended
(Note: If Recommendations for clinical privileges include a condition, modification or are not recommended, the
specific condition and reason for the same must be stated on the last pages of this form)

(R) CORE PRIVILEGES FOR RESIDENT DOCTORS (A) (C) (N)

▫ ▫ ▫ ▫
OUT PATIENT DEPARTMENT
Attend, give consultation to patients.
Fill and document required forms (Investigation requisition forms, admission advice
form).

▫ ▫ ▫ ▫
ADMISSION OF PATIENTS
Take history and examine the patient, ensure investigations and provide treatment
as per the instructions of consultant. Documentation of same in the patient case files
with date, time, name and sign.

▫ ▫ ▫ ▫
ADMITTED PATIENTS
 Take and give handover to the night/on call resident, attend emergency call
on the floor immediately.
 Take round independently as well as with the consultant as per hospital
policy and record all medical details (patient’s progress, vitals,
input/output, investigation results and scheduled investigation/procedure) in
the patient case file and explain same to the floor sister.
 Coordinate and inform the consultant about any abnormal findings of
investigations and do procedures assigned by the consultant.
 Ensure sample collection and report reach on time and same should be
conveyed to respective consultants.

▫ ▫ ▫ ▫
DISCHARGE OF PATIENT
 Prepare discharge/death summary within defined time frame.
 Explain details regarding further treatment, precautions, follow up
 Clinical Privileges for Resident
Doctors

procedures and preventive measures to the patient before discharge.

▫ ▫ ▫ ▫
EMERGENCY DEPARTMENT
▫ ▫ ▫ ▫
Will attend(immediately), assess, stabilize the patient in the triage of Emergency
Department when called by the EMO and document initial assessment in the ED
registration card
▫ ▫ ▫ ▫
In case emergency surgery is needed, will prepare the patient for the same;
 Send investigations
 Get PAC done
 Shift patient to OT
Assist surgeon in the surgery

SPECIAL PRIVILEGES FOR RESIDENT DOCTORS

(A) (C) (N)

SPECIAL PRIVILEGE IN ANAESTHESIA
(R)
Management of patients rendered unconscious or insensible to pain and emotional
▫ stress during Surgical, Obstetrical and certain other Medical procedures including ▫ ▫ ▫
Preoperative, Intraoperative and Postoperative evaluation and treatment, the
support of life functions and vital organs under the stress of Anesthetic, Surgical and
other Medical procedures, Management of problems in Pain relief, Cardiopulmonary
Resuscitation, Pulmonary care, Supervision of patients in Post-anesthesia Care Units
and critically ill patients in special care units

SPECIAL PRIVILEGE IN GENERAL SURGERY (A) (C) (N)

(R)

▫ Admit , evaluate, diagnose and provide Pre-intra and Post operative surgical care ▫ ▫ ▫
and performance of surgical care and surgical procedures to patients of ages greater
than 12 years except where specifically excluded from practice, to correct or treat
various conditions and injuries of the Alimentary tract, Abdomen and its contents,
Breast, Skin and soft tissue, Head and Neck, Endocrine system and Minor Extremity
surgery. Privileges include but not limited to insertion and management of Arterial
Catheter, insertion and management of Chest tube, in patients with underlying
surgical conditions in the Emergency department, Intensive care unit.

TRAUMA SERVICE
▫ Performance of Surgical procedures, admission, consultation, work-up, peri- ▫ ▫ ▫
operative care to correct and treat traumatic injuries. This includes the
comprehensive management of trauma including Musculoskeletal, Multi-system
injuries, Thoracic and Abdominal injuries, hand and head injuries. The General
surgeon must coordinate all aspects of treatment including resuscitation, operation,
critical care, recuperation and rehabilitation or discharge.

(R) SPECIAL PRIVILEGE IN GENERAL INTERNAL MEDICINE (A) (C) (N)

 Clinical Privileges for Resident
Doctors

▫ ▫ ▫ ▫
Admit, evaluate, diagnose and provision of non surgical treatment including
consultation for patients above the age of 12 years admitted or in need of care to
treat general medical problems and includes following:

▫ Thoracentesis ▫ ▫ ▫
▫ Bone marrow ▫ ▫ ▫
▫ Lumbar puncture ▫ ▫ ▫
▫ Tissue biopsy ▫ ▫ ▫
▫ Abscess drainage ▫ ▫ ▫
▫ Thrombolytic therapy ▫ ▫ ▫
▫ Iron infusion ▫ ▫ ▫
▫ Paracentesis ▫ ▫ ▫
▫ Ventilator Management ‹ 24 hours ▫ ▫ ▫
▫ Insertion and Management of a Central Venous Catheter ▫ ▫ ▫
(R) (A) (C) (N)
SPECIAL PRIVILEGE IN ORTHOPAEDIC SURGERY

▫ ▫ ▫ ▫
Admit, evaluate, diagnose and provision for non surgical care to patients of all ages,
except where specifically excluded from practice, to correct or treat various
conditions and illness and injuries of the Musculoskeletal system such as multiple
fractures, fractures associated with multiple injuries, complex fracture (including
Pelvic, Acetabular, Intra-articular and Spinal cord column and high grade soft tissue
injuries including the provision of consultation

SPECIAL PRIVILEGE IN PAEDIATRICS (A) (C) (N)

(R) Includes admission, consultation, evaluation, diagnosis and non-surgical treatment of
patients (<12 years) with general medical problems and includes:

▫ Lumbar Puncture ▫ ▫ ▫
▫ Central line-femoral/subclavian/jugular ▫ ▫ ▫
▫ Soft tissue Injections ▫ ▫ ▫
▫ Excision/drainage of superficial skin abscesses ▫ ▫ ▫
▫ Emergency Umbilical Catheterization ▫ ▫ ▫
▫ Emergency Resuscitation/Stabilization of the sick and newborn ▫ ▫ ▫
▫ Bone marrow aspiration and biopsy ▫ ▫ ▫
 Clinical Privileges for Resident
Doctors

▫ Pleural fluid aspiration (Pleural tap) ▫ ▫ ▫

▫ Peritoneal tap ▫ ▫ ▫
▫ Liver biopsy ▫ ▫ ▫
▫ Kidney biopsy ▫ ▫ ▫
▫ Intraosseous line ▫ ▫ ▫
(R) SPECIAL PRIVILEGE IN CRITICAL CARE (A) (C) (N)

Admit, evaluate, diagnose and provide non-surgical treatment to patients above 12

▫ years. Privileges include but not limited to ECG Interpretation ▫ ▫ ▫
▫ Arterial puncture for blood gas analysis ▫ ▫ ▫
▫ ▫ ▫ ▫
Lumbar puncture

▫ ▫ ▫ ▫
Thoracentesis

▫ ▫ ▫ ▫
Abdominal Paracentesis

▫ ▫ ▫ ▫
Central Venous Access: Internal Jugular or Femoral or Subclavian

▫ ▫ ▫ ▫
Trans-venous Pacing

SPECIAL PRIVILEGE IN OBSTETRICS (A) (C) (N)

(R)

▫ ▫ ▫ ▫
Admit, evaluate, diagnosis, consultation and Pre-intra and Post-operative care
necessary to correct or treat female patients with obstetrical problems.

▫ ▫ ▫ ▫
Normal delivery,

▫ ▫ ▫ ▫
Lower segment caesarean section

▫ ▫ ▫ ▫
Complicated delivery (It includes PIH, diabetes, heart disease, eclampsia, previous
scar, extensive adhesions and other medical disorders)

▫ ▫ ▫ ▫
Suction evacuation

▫ ▫ ▫ ▫
 Clinical Privileges for Resident
Doctors

Hysterectomy with ligation

▫ ▫ ▫ ▫
Resuturing of episiotomy, Cervical tear stitching

▫ ▫ ▫ ▫
Caesarean hysterectomy

▫ ▫ ▫ ▫
ARM (Artificial rupture of membrane), MRP (Manual removal of placenta), Repair of
third degree tear

(A) (C) (N)

(R) SPECIAL PRIVILEGE IN GYNAECOLOGY

▫
Admit, evaluate, diagnose, consultation and Pre-intra and Post-operative care ▫ ▫ ▫
necessary to correct or treat female patients of all ages presenting with illness,
injuries and disorders of Gynaecologic or Genitourinary system and Non-surgical
treatment of illnesses and injuries of the Mammary glands.

Acknowledgement of Resident Doctor:

I have requested only those privileges for which by education, training, current experience and demonstrated
performance. I am qualified to perform and for which I wish to exercise at Moolchand Hospital and I understand
that:

 In exercise any clinical privileges granted, I am constrained by Hospital rules and guidelines applicable
generally and any applicable to the particular situations.

 Any restrictions on the clinical privileges granted to me are waived in an emergency situation and in such
situation my actions are governed by the applicable section of the Hospital guidelines or related
documents.

Signed:…………………………………………………………………………………… Date:
(Applicant Signature)

Signed: …………………………………………………………………………………
(Director Medical Services)

Signed: …………………………………………………………………………………
(CEO)