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 2018                            December 1, 2017                   January 9, 2018                         January 15, 2018
Deadline - January 12               
January 17, 2018                  January 25, 2018               
 February 2018 January 1, 2018 February 6, 2018   February 12, 2018
Deadline - February 9
February 14, 2018 February 22, 2018 
 March 2018 February 1, 2018 March 6, 2018  March 19, 2018
Deadline - March 16 
March 21, 2018  March 29, 2018 
 April 2018 March 1, 2018  April 10, 2018  April 16, 2018
Deadline - April 13 
April 18, 2018  April 26, 2018 
 May 2018 April 1, 2018  May 8, 2018  May 14, 2018
Deadline - May 11 
May 16, 2018  May 24, 2018 
 June 2018 May 1, 2018  June 12, 2018  June 18, 2018
Deadline - June 15 
June 20, 2018  June 28, 2018 
 July 2018 June 1, 2018  July 10, 2018  July 16, 2018
Deadline - July 13
July 18, 2018 July 26, 2018 
August 2018 July 1, 2018  August 7, 2018  August 13, 2018
Deadline - August 10 
August 15, 2018  August 23, 2017 
September 2018 August 1, 2018  September 11, 2018  September 17, 2018
Deadline - September 14 
September 19, 2018  September 27, 2018 
October 2018 September 1, 2018  October 9, 2018  October 15, 2018
Deadline - October 12
October 17, 2018  October 25, 2018 
November 2018 October 1, 2018  October 30, 2018  November 5, 2018
Deadline - November 2
November 7, 2018  November 15, 2018 
December 2018 November 1, 2018  December 4, 2018  December 10, 2018
Deadline - December 7
December 12, 2018  December 20, 2018 

       
 

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 (382 KB)

Rules and Regulations Rules and Regulations (181 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)