Clinical Privilege Document
Cardiology Department – Neon Hospital
Issued To:
Name: Dr. Saurab Santosh Dhariya
Qualification: MBBS, DNB (Interventional Cardiology)
Registration Number: 2011/05/1464
Designation: Consultant Cardiologist
Effective Date:
Revision Date:
Purpose
This document defines the clinical privileges granted to Dr. Saurab Santosh Dhariya, ensuring the delivery of high-quality
cardiac care in compliance with Neon Hospital’s standards and patient safety protocols.
Scope of Clinical Privileges
1. Outpatient Services
Conduct consultations for adult and pediatric cardiac patients.
Perform non-invasive diagnostics, including:
o ECG
o Stress testing
o Echocardiograms (2D, Doppler, Transesophageal)
Manage follow-ups for chronic cardiac conditions.
2. Inpatient Services
Provide care for hospitalized cardiac patients.
Manage pre-operative and post-operative cardiac cases.
Supervise treatment in the Cardiac Intensive Care Unit (CICU).
3. Diagnostic and Interventional Procedures
Perform and interpret:
o Electrocardiography (ECG)
o Holter monitoring and event recording
Invasive procedures (authorized):
o Cardiac catheterization
o Percutaneous coronary interventions (PCI) such as angioplasty and stenting
o Pacemaker and defibrillator implantation
o Percutaneous valvuloplasty procedures
4. Emergency Cardiac Services
Manage cardiac emergencies, including:
o Acute myocardial infarction
o Arrhythmias
o Cardiogenic shock
Lead Advanced Cardiac Life Support (ACLS) efforts.
Oversee the hospital's cardiac emergency response protocols.
5. Multidisciplinary Collaboration
Collaborate with neonatologists for neonatal cardiac management.
Assist in diagnosing and managing congenital cardiac anomalies.
Provide assessments for pre-surgical and post-surgical neonatal cardiac care.
Responsibilities
1. Maintain accurate patient records and procedural documentation.
2. Comply with Neon Hospital’s clinical protocols, ethical standards, and regulatory requirements.
3. Participate in hospital-led quality improvement initiatives and audits.
4. Regularly update skills through mandated training and certifications.
Exclusions
Procedures outside granted privileges require prior approval from the Credentialing Committee.
Services not aligned with the hospital’s scope of practice.
Approval and Acknowledgment
Credentialing Committee Approval:
Signature: ___________________________
Name: _______________________________
Designation: __________________________
Date: _______________________________
Acknowledgment by Dr. Saurab Santosh Dhariya:
I, Dr. Saurab Santosh Dhariya, accept the clinical privileges outlined above and commit to adhering to Neon Hospital’s
standards and policies.
Signature: ___________________________
Date: _______________________________
