ANNUAL REQUIREMENTS FORM
September
2009
Please
print
ANNUAL REQUIREMENTS FORM
September
2009 |
| Listed below are the annual requirements for Physician Employed Personnel to practice at Pitt County Memorial
Hospital. Please initial by each
requirement and submit this document with your original signed supporting
documentation in hard copy to Patient Care Services Administration, Pitt
County Memorial Hospital, Attention: Lisa James, 2100 Stantonsburg Road,
Greenville, NC 27834. Please call 847-5243 if you have any
questions or need additional information. Thank you.
|
================================================================
Name___________________________Physician____________________Department_________________
Speciality___________________________Managers
Name & Email address_________________________
Requirements to Practice at Pitt County Memorial Hospital
|
|
|
|
-
Submit copies of license, certificate of liability insurance and job
description. |
|
|
|
|
|
-
Submit copies of license, certificate of liability insurance and job
description. |
|
|
Annual Requirements: |
|
|
|
|
|
|
|
|
Computer Access to Healthspan |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
EOC – Safety, Emergency Management,
General Infection Control and Patient Rights
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Modules highlighted in orange above – please
submit printed copy of score. |
|
All other requirement above – please
submit signed original form. |
|
Other documents to review: |
|
|
|
|
|
|
Please sign:__________________________________________Date__________________________
Email
address:______________________________________________________________________
|
SUBMIT INFORMATION TO:
Patient Care Services Administration, Pitt
County Memorial Hospital, Attention: Lisa James, 2100 Stantonsburg Road,
Greenville, NC 27834.
Please call 847-5253 if you have any
questions or need additional information. Thank you.
HOSPITAL LOCATION:
Pitt County Memorial Hospital is located on
the western edge of Greenville, on Stantonsburg Road
(US 264). The Visitors’ and Patients’
entrances are located on Moye Boulevard just off Stantonsburg Road. Visitor parking is available directly in front of the Visitors’
Entrance. We are including maps of our campus and the Greenville area for your convenience.
PITT COUNTY MEMORIAL HOSPITAL ADDRESS:
Pitt County Memorial Hospital
2100 Stantonsburg Road
PO Box 6028
Greenville, North Carolina 27835-6028
Last updated – September 2009
|