Find-A-Physician Registry

Thank you for accepting your invitation to the Find-A-Physician Registry. Please complete the following information to finish your enrollment.

Is this a new submission or an update to an existing submission?

New

Update

Please indicate which procedures the physician performs. The physician will need to meet all of the criteria in order to be added to the corresponding registry.

Colon Surgery

Physician meets all of the following criteria:

Physician has performed at least 20 Laparoscopic Colectomy procedures for benign or metastatic colon cancer within the last 12 months.

Yes

Hemorrhoid Surgery

Physician meets all of the following criteria

Physician is a colorectal or general surgeon who has been trained on the PPH procedure (with documentation on file) and performed at least 4 cases in the last 12 months.

Yes

Hysterectomy

Physician meets all of the following criteria:

Physician has performed at least 50 hysterectomy procedures in the last 12 months AND at least 60% of those procedures were minimally invasive.

Yes

Incontinence Surgery

Physician meets all of the following criteria:

Physician has performed at least 50 Incontinence surgeries within the last 12 months.

Yes

Thoracic Surgery

Physician meets all of the following criteria:

Physician has performed at least 25 Video Assisted Thoracic Lobectomies for benign or metastatic lung cancer within the last 12 months.

Yes

Ventral Hernia Repair

Physician meets all of the following criteria:

Yes

Weight Loss Surgery – Band

Physician meets all of the following criteria:

Institution has credentialing guidelines in place for Bariatric Surgery.
Surgeon meets institution's credentialing guidelines.
Institution has an ongoing and regularly scheduled in-service education program for bariatric surgery in place.
Appropriate Consultative Services available from applicant hospital within 30 minutes of request.
Maintains a full line of equipment and instruments for the care of bariatric surgical patients.
Bariatric surgeon has qualified coverage and support for patient care in the absence of the primary surgeon.
Utilizes Clinical Pathways and orders to facilitate standardization of care
Utilizes designated nurses or physician extenders who routinely care for bariatric patients.
Post-op patient support system in place and a licensed healthcare professional must either lead or be present for support group meetings.
System in place for long-term patient follow-up and outcomes tracking.
Surgeon has performed at least 125 bariatric procedures with at least 50 of those cases performed during the 12 months or have performed a minimum of 15 banding procedures in their lifetime. (Performed is defined as conducing a significant part of the operation as the primary surgeon. Applicants may not include cases where they served as the assisting surgeon. Applicants may include up to 75 operations performed during their fellowship in their total lifetime account).

Yes

Weight Loss Surgery - Bypass

Physician meets all of the following criteria:

Institution has credentialing guidelines in place for Bariatric Surgery.
Surgeon meets institution's credentialing guidelines.
Institution has an ongoing and regularly scheduled in-service education program for bariatric surgery in place.
Appropriate Consultative Services available from applicant hospital within 30 minutes of request.
Maintains a full line of equipment and instruments for the care of bariatric surgical patients.
Bariatric surgeon has qualified coverage and support for patient care in the absence of the primary surgeon.
Utilizes Clinical Pathways and orders to facilitate standardization of care
Utilizes designated nurses or physician extenders who routinely care for bariatric patients.
Post-op patient support system in place and a licensed healthcare professional must either lead or be present for support group meetings.
System in place for long-term patient follow-up and outcomes tracking.
Surgeon represents that he/she as performed at least 125 bariatric procedures with at least 50 of those cases performed during the past 12 months or have performed a minimum of 15 bypass procedures in their lifetime. (Performed is defined as conducing a significant part of the operation as the primary surgeon. Applicants may not include cases where they served as the assisting surgeon. Applicants may include up to 75 operations performed during their fellowship in their total lifetime account.)

Yes

Weight Loss Surgery – Sleeve

Physician meets all of the following criteria:

Institution has credentialing guidelines in place for Bariatric Surgery.
Surgeon meets institution's credentialing guidelines.
Institution has an ongoing and regularly scheduled in-service education program for bariatric surgery in place.
Appropriate Consultative Services available from applicant hospital within 30 minutes of request.
Maintains a full line of equipment and instruments for the care of bariatric surgical patients.
Bariatric surgeon has qualified coverage and support for patient care in the absence of the primary surgeon.
Utilizes Clinical Pathways and orders to facilitate standardization of care
Utilizes designated nurses or physician extenders who routinely care for bariatric patients.
Post-op patient support system in place and a licensed healthcare professional must either lead or be present for support group meetings.
System in place for long-term patient follow-up and outcomes tracking.
Surgeon represents that he/she has performed at least 125 bariatric procedures with at least 50 of those cases performed during the last 12 months and a minimum of 15 sleeve gastrectomy procedures performed in their lifetime. (Performed is defined as conducing a significant part of the operation as the primary surgeon. Applicants may not include cases where they served as the assisting surgeon. Applicants may include up to 75 operations performed during their fellowship in their total lifetime account.)

Yes

Surgeon Information

(Asterisk indicates a required field)

Hospitals where you have Privileges

Physician First Name

Physician Last Name

Name of Practice/Location

Office Contact Name

Street Address

City

State

Zip Code

Primary Phone Number

Email address

Website address

Would you like to opt in to receive future communication from Ethicon?

Yes

Comments

I Agree

By checking this box, I agree that the above physician meets the qualifications as shown above. I confirm that I am either the above named physician or a delegate in this matter and that the above physician has authorized me to submit this data on their behalf.

My Full Name

Submitter Name

Submitter Email

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