Alert: Because flu cases are on the rise, children 12 and younger will be restricted from visiting hospitals and certain inpatient facilities. Learn more.

To request a change in classification or to request clinical privileges at any or all of the Carolinas HealthCare System facilities please complete and submit this form. Please note that you must have current membership at of the CHS facilities listed.
Please Select Desired Clinical Privilege Location and/or Classification Change. Changes to the Affiliate and or Telemedicine Classification may require an update to your delineation of privileges form).