Delineation of privileges 2026

1. Click ‘Get Form’ to open the delineation of privileges document in the editor.
2. Begin by entering your name at the top of the form. This personalizes your application and ensures proper identification.
3. For each section, such as General Dentistry, Diagnostic Procedures, and Preventive Procedures, check 'Yes' or 'No' to indicate whether you are requesting these privileges.
4. In the 'Granted' column, mark 'Yes' or 'No' based on whether these privileges have been granted to you previously.
5. If applicable, specify any additional procedures in the provided spaces under each category. This allows for a comprehensive overview of your qualifications.
6. Finally, sign and date the application at the bottom to confirm your request for specific privileges.

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