21 NCAC 52 .0212             SPECIALTY CREDENTIALING PRIVILEGES

(a)  The Board shall grant surgical specialty privileges to podiatrists in the areas of amputation, ankle surgery, and club foot correction.

(b)  Application for such privileges shall be made upon a form provided by the board (available from the board's website at http://www.ncbpe.org) along with two copies of the applicants' surgery logs, both of which shall be highlighted in different colors (one color per specialty area, i.e. amputations, ankle surgeries, and club foot corrections).

(c)  The application shall request the following information from the licensee:

(1)           Name;

(2)           Address;

(3)           License number;

(4)           Telephone;

(5)           Number of years, type, and location of post-graduate training;

(6)           Board certification(s) type and year;

(7)           Whether or not a Fellow of the American College of Foot & Ankle Surgeons and year of bestowal;

(8)           Other postgraduate continuing medical education;

(9)           Hospital affiliation(s), privileges, dates, and whether or not surgical or non-surgical;

(10)         Surgery center affiliations, privileges, dates, and whether or not surgical or non-surgical;

(11)         Teaching appointments, locations, years of affiliation, and type of appointment;

(12)         Which privilege(s) the applicant is applying for (e.g., ankle surgery, amputations, surgical correction of clubfoot);

(13)         Signature; and

(14)         Date of application.

History Note:        Authority G.S. 90‑202.2;

Eff. June 1, .2011;

Readopted Eff. September 1, 2016.