• Updated Current Curriculum Vitae (must include month and year)
• Government issued photo ID (i.e. Driver’s License, Passport Photo, etc.)
• A copy of your current Malpractice Insurance:
  • Primary Insurance of ($1,300,000/ $3,900,000)
  • Excess Insurance of ($1, 000, 000/ $3,000, 000)
• Copy of your current New York State Registration
• Copy of other current licenses and registrations
• Copy of your DEA License Registration with New York State address
• Current Infection Control Certificate
• Proof of Board Certification and/ or Re-certification
• Signed Consent to Release from Liability - To be mailed or faxed to Medical Affairs Department
• Completed and Signed Authorization to obtain Malpractice Claims History
• Copies of CME Credits Certificates (50 category 1 credits for the period 2008 to 2009) 
• ACLS certification for Anesthesia Department
• PALS certification for Anesthesia Department
• The Medical Health Status Evaluation – To be completed by a physician who is NOT a first degree relative, spouse, significant other or business partner.  You must download and print this form and return it with your application or mail it separately after your physical exam, BUT PRIOR TO FEBRUARY 16, 2010.
• Non-Refundable re-appointment fee of $400. made payable to NYEE  

Delineation of Privileges forms (if required) can be downloaded from this website. Please be reminded that your re-appointment will be delayed if the following item is delinquent:

• Completion of Medical Records

The Medical Board has approved a Late Fee of $500 to be imposed without exception on applicants whose reappointment materials are not received completed by the due date. This policy will be strictly enforced.

• Use of Clinical Privileges granted
• Number of surgeries as a primary surgeon
• Number of surgeries as assisting surgeon
• Laser usage (private or service cases)
• Patient admissions
• Clinic attendance and participation
• Teaching of surgery with Residents
• Clinic and in-patient consultations
• On-call (esp. Metropolitan Eye Trauma Service)
• Participation in departmental meetings
• Educational/academic endeavors

• Electronic submission with signature
• Signed and mail to the Medical Affairs Office

Your re-appointment application is not completed until ALL supporting documents are submitted from the re-appointment check list.

You will be able to review (and correct as needed) the information currently in your file. (Your computer must have Adobe Acrobat Reader (version 8 or higher) to access the forms.)