Initial Applications

 

Please complete the applicable application form and clinical privilege documents (Step 1 and 3) to begin the credentialing process. These
documents must be completed and submitted to the Medical Staff Office at least 30 days prior to the scheduled Credentials Committee
meeting in order to be added to the Credential's Committee agenda (information regarding important credentialing deadlines is provided below).
Most applications typically take about 30 days for processing by the Medical Staff Office. Some may take less time depending on the amount
of information that must be verified. Applications that are returned incomplete may take longer to process.

Please note: Applications must be completed by the applicant. Applicants who attest to the completeness and accuracy of their application,
but fail to provide a complete and accurate application risk the chance that their file may not be approved.

All files must be presented to and reviewed by the Credentials Committee prior to privileges being approved. The only exception to this rule is
when there is a documented urgent/emergent patient care need. Applicants classified by the Credentials Committee as Category I applicants
may be approved through an expedited approval process. Category I applicants presented to MEC for approval will be expedited during the
next QA/PI meeting. All other applicants will be presented at the Board for final approval.

                                                                                           

Credentialing Application Deadlines

Approval Month
(approval occurs towards
the end of the month)
Full Application
Must be Received By
Credentials Committee
(Agenda will not be
revised after 10am on
the day of the meeting)
MEC
(Agenda will not be
revised after 12pm on
Friday prior to meeting)
QA/PI Board
 January 2017                            December 1, 2016                   January 10, 2017                         January 16, 2017
Deadline - January 13               
January 18, 2017                  January 26, 2017               
 February 2017 January 1, 2017 February 7, 2017   February 13, 2017
Deadline - February 10
February 15, 2017 February 23, 2017 
 March 2017 February 1, 2017 February 28, 2017  March 6, 2017
Deadline - March 3 
March 15, 2017  March 23, 2017 
 April 2017 March 1, 2017  April 11, 2017  April 17, 2017
Deadline - April 14 
April 19, 2017  April 27, 2017 
 May 2017 April 1, 2017  May 9, 2017  May 15, 2017
Deadline - May 12 
May 17, 2017  May 25, 2017 
 June 2017 May 1, 2017  June 6, 2017  June 12, 2017
Deadline - June 9 
June 14, 2017  June 22, 2017 
 July 2017 June 1, 2017  July 11, 2017  July 17, 2017
Deadline - July 14
July 19, 2017 July 27, 2017 
August 2017 July 1, 2017  August 8, 2017  August 14, 2017
Deadline - August 11 
August 16, 2017  August 24, 2017 
September 2017 August 1, 2017  September 12, 2017  September 18, 2017
Deadline - September 15 
September 20, 2017  September 28, 2017 
October 2017 September 1, 2017  October 10, 2017  October 16, 2017
Deadline - October 13
October 18, 2017  October 26, 2017 
November 2017 October 1, 2017  October 31, 2017  November 6, 2017
Deadline - November 3
November 8, 2017  November 16, 2017 
December 2017 November 1, 2017  December 5, 2017  December 11, 2017
Deadline - December 8
December 13, 2017  December 21, 2017 

       
 

Step 1 - Application Forms

Print and complete ALL pages of the initial application listed below. 

Initial Application (NPs/PAs/CRNAs/RNFAs/Clinical Psychologists) Initial Application (NPs/PAs/CRNAs/RNFAs/Clinical Psychologists) (765 KB)

Initial Application (Physicians/Dentists) Initial Application (Physicians/Dentists) (945 KB)

 

Step 2 - Information Related to Application Forms 

It is not necessary to print the Medical Staff Bylaws and related manuals. They are provided for your review as you complete your application documents. 

Medical Staff Bylaws Medical Staff Bylaws (670 KB)

Rules and Regulations Rules and Regulations (396 KB)

 

Step 3 - Clinical Privilege Documents 

Print and complete only the applicable documents in this section.

Physician/Dentist Forms

Allergy Allergy (15 KB)

Anesthesiology Anesthesiology (39 KB)

Bariatric Surgery Bariatric Surgery (158 KB)

Cardiology Cardiology (82 KB)

Cardiothoracic and Vascular Surgery Cardiothoracic and Vascular Surgery (33 KB)

Critical Care Medicine Critical Care Medicine (148 KB)

Dental and Oral Surgery Dental and Oral Surgery (27 KB)

Dermatology Dermatology (15 KB)

Emergency Medicine Emergency Medicine (20 KB)

Endocrinology Endocrinology (15 KB)

Family Medicine Family Medicine (33 KB)

Gastroenterology Gastroenterology (23 KB)

General Surgery General Surgery (43 KB)

Hematology Oncology Hematology Oncology (17 KB)

Infectious Disease Infectious Disease (24 KB)

Internal Medicine Internal Medicine (34 KB)

Neonatology Neonatology (71 KB)

Nephrology Nephrology (16 KB)

Neurology Neurology (18 KB)

Neurosurgery Neurosurgery (41 KB)

Ophthalmology Ophthalmology (71 KB)

Orthopedic Surgery Orthopedic Surgery (30 KB)

Otolaryngology Otolaryngology (19 KB)

Pain Management Pain Management (53 KB)

Pathology Pathology (13 KB)

Plastic Surgery Plastic Surgery (21 KB)

Psychiatry Psychiatry (31 KB)

Pulmonology Pulmonology (34 KB)

Radiation Oncology Radiation Oncology (25 KB)

Radiology Radiology (56 KB)

Rheumatology Rheumatology (17 KB)

Urology Urology (42 KB)

Women's Health Women's Health (38 KB)

Wound Care Wound Care (184 KB)

 
APP Forms

CRNA CRNA (127 KB)

NP - Acute Care NP - Acute Care (128 KB)

NP - Behavioral Health NP - Behavioral Health (123 KB)

NP - Family NP - Family (121 KB)

NP - Neonatology NP - Neonatology (127 KB)

Physician Assistant Physician Assistant (72 KB)

Psychologist Psychologist (126 KB)

RNFA RNFA (138 KB)