Ill. Admin. Code tit. 77, pt. 515, subpt. K, app G

Current through Register Vol. 48, No. 49, December 6, 2024

Appendix G - Credentials of General/Trauma Surgeons Level I and Level II

List each surgeon by name

Check appropriate categories regarding trauma care experience and operating room privileges

Signed by CEO/Hospital Administrator

Surgeon Name	T= Trauma Surgeon G= General Surgeon	Two years post-residency trauma care experience	Independent OR privileges	20 hrs. for every two years trauma-related CME
_____	_____	_____	_____	_____
_____	_____	_____	_____	_____
_____	_____	_____	_____	_____
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_____	_____	_____	_____	_____
_____	_____	_____	_____	_____
_____	_____	_____	_____	_____
_____	_____	_____	_____	_____

_______________________________________

Signature

Hospital CEO/Administrator

__________________________________________________

Typed NameDate

Hospital CEO/Administrator

Ill. Admin. Code tit. 77, pt. 515, subpt. K, app G

Amended at 25 Ill. Reg. 16386, effective December 20, 2001