WESTERN REGIONAL INTEGRATED HEALTH AUTHORITY
DISCIPLINE OF SURGERY
Subspeciality: Ophthalmology
I hereby apply for the following privileges:
OPHTHALMOLOGY PRIVILEGES
Entropion Correction
Ectropion Correction
Repair of Eyelid Laceration
Repair of Lacerated Lacrimal Canaliculus
Excision of Eyelid Lesions
Rotation Flap for Closure of Eyelid defect
Lower and Upper Eyelid Bridge Flap
Tarsoconjunctival Flap
Skin Graft
Free Composite Eyelid Graft
Blepharoplasty
Ptosis Surgery-Levator Resection of Fasanella Savat Operation
Ptosis Surgery-Levator Resection of Fasanella Savat Operation
Ptosis Surgery-Frontalis Sling Operation using Synthetic Material
-Frontalis Sling Operation using Fascia Lata
Tarsal Surgery for Distichiasis or Trichiasis
Tarsorrhaphy
Lid Lengthening Procedure with Scleral Graft
Incision of Stye, Abscess
Lacrimal Tract
Syringing, Probing, Dilation
Insertion of Inlying Tubes
3 Snip Punctum Procedure, Retropunctal Cautery
Incision of Abscess
Excision of Sac
Dacryocystorhinostomy
Lacrimal Bypass Procedure (i.e. Lester Jones Tubes)
Orbit
Drainage of Abscess
Excision of Orbital Lesion
Removal of Orbital Foreign Body
Lateral Orbitotomy
Orbital Decompression 2 walls or 3 walls
Orbital Reconstruction with Dermis Fat Graft or Conjunctival Graft
Fornix Reconstruction with Mucous Membrane Graft
Exenteration
Enucleation
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Ophthalmology Privileges
Orbit (continued)
Evisceration
Insertion of Orbital Implant
Repair of Orbital Fracture
Removal of Orbital Implant
Extraocular Muscles
Horizontal Rectus Muscle Surgery
Vertical Rectus Muscle Surgery
Oblique Muscle Surgery
Cataract Surgery
Intracapsular Cataract Extraction
Extracapsular Cataract Extraction by Infusion/Aspiration Technique
Phacoemulsification
Anterior Vitrectomy by Infusion Suction Cutter Technique
Anterior Vitrectomy by Sponge/Scissor Technique
Corneal and Conjunctival Surgery
Removal of Embedded Corneal Foreign Body
Chelation of Band Keratopathy
Excision of Pterygium, Dermoid
Conjunctival Transplant
Conjunctival Flap
Application of glue to cornea
Corneal Transplant, Lamellar or Penetrating
Penetrating Injury
Repair or Penetrating Injury of Cornea or Sclera
Removal of Intraocular Foreign Body
Retina and Vitreous
Surgery for Detached Retina
Removal of Scleral Implant
Pars Plana Vitrectomy
Endolaser, Endodiathermy
Membrane Peeling/Disection
Gas Fluid Exchange
Glaucoma Surgery
Peripheral Iridectomy
Filtration Surgery
Insertion of Valve/Pump
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Ophthalmology Privileges
Laser
Iridotomy
Irodoplasty
Trabeculoplasty
Pupilloplasty
YAG-Capsulotomy / Vitriolysis / Membranectomy
Laser Therapy for Retinal Disorders
Retinal tear/hole
Vascular Diseases of Retina
Diabetic Retinopathy
RPE Defects in retina causing leak/pooling
Choroidal Neovascularization
Rubeosis Iridis
Signed:
Applicant:
Date:
Signed:
Regional Chief of Discipline, Surgery Date:
Date
Signed:
Region Medical Advisory Committee
Date:
Signed:
Western Regional Integrated Health Authority
Date:
Revised Date: May 1998
Discipline of Surgery
Approved by:
Form # 12 – 1630