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Application Request for Privileges

Who is eligible to apply for Membership and Clinical Privileges on the Medical Staff?

Medical Doctors (MD and DO) and podiatrists (DPM), advanced practice registered nurses (APRN) and physician assistants (PA) are eligible.

How do I request an application?

A written request must be submitted to the Medical Staff Office. For your convenience, an online request form is provided below.

Following approval by the Chief Executive Officer, you will be provided with a preapplication. The completed forms must be submitted along with all requested documents to the Medical Staff Office.

The Chief Executive Officer will review the preapplication form. Following approval, you will be supplied with the full application via mail or informed otherwise.

How do I submit the application and what happens next?

The original completed application and required documents must be returned to the Medical Staff Office. A postage paid return envelope is provided for your convenience. Receipt of the application and documents will be acknowledged by email or letter. If you have not received an acknowledgement within one week, please contact the Medical Staff Office.

The application will be thoroughly reviewed and processed. This includes review and verification of credentials, training, references, current and prior affiliations, other information in the application, background check and other verifications as required by hospital policy.

When the application has been deemed complete, it will be submitted to the Medical Staff President for review and then will be forwarded to the Medical Staff, the Board Credentials Committee, and the Board of Directors. This process normally takes approximately four to eight weeks. Please note that temporary privileges are not issued except in extremely rare instances.

Online application request