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 2019             December 1, 2018                   January 8, 2019                         January 14, 2019
Deadline - January 11               
January 16, 2019                  January 24, 2019               
 February 2019 January 1, 2019 February 12, 2019   February 18, 2019
Deadline - February 15
February 20, 2019 February 28, 2019 
 March 2019 February 1, 2019 March 12, 2019  March 18, 2019
Deadline - March 15 
March 20, 2019  March 28, 2019 
 April 2019 March 1, 2019 April 9, 2019  April 15, 2019
Deadline - April 12 
April 17, 2019  April 25, 2019 
 May 2019 April 1, 2019 May 7, 2019  May 13, 2019
Deadline - May 10 
May 15, 2019  May 23, 2019 
 June 2019 May 1, 2019  June 11, 2019  June 17, 2019
Deadline - June 14 
June 19, 2019  June 27, 2019 
 July 2019 June 1, 2019  July 9, 2019  July 15, 2019
Deadline - July 12
July 17, 2019 July 25, 2019 
August 2019 July 1, 2019 August 6, 2019  August 12, 2019
Deadline - August 9 
August 14, 2019  August 22, 2019 
September 2019 August 1, 2019 September 10, 2019  September 16, 2019
Deadline - September 13 
September 18, 2019  September 26, 2019 
October 2019 September 1, 2019  October 8, 2019  October 14, 2019
Deadline - October 11
October 16, 2019  October 24, 2019 
November 2019 October 1, 2019 November 5, 2019  November 11, 2019
Deadline - November 8
November 13, 2019 November 21, 2019 
December 2019 November 1, 2019  December 3, 2019  December 9, 2019
Deadline - December 6
December 11, 2019  December 19, 2019 

       
 

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 (182 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)

Spine Surgery Spine Surgery (173 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)