Medical Staff Member Referral Form

Reasonable concern exists if facts and/or circumstances indicate that a Medical Staff Member is not performing his or her professional duties as expected.  Concern may be based on, but not limited to, the following: Observed signs or behaviors from using or being under the influence of alcohol or drugs, erratic/bizarre behavior compared to expected behavior, inappropriate conduct, or illness affecting ability to exercise privileges.  You are not responsible for identifying the cause of the problem.

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