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New Applicants: What You Should Know

If you are a new medical staff applicant, theÌýMedical Staff Coordinator for your service will assist you with the credentialing application process, including providing access to your Practitioner Portal.

Credentialing application steps:

1.Ìý For Stanford School of Medicine Faculty applicants please work with your hiring department to complete the information via the link.Ìý For all other applicants please complete thisÌýbrief application request form.

2. Requests are processed in 1-2 business days. After your request has been processed you will receive two emails with your Practitioner Portal access information.

3. Complete the application and supporting documents as outlined on your Practitioner Portal.

4. YouÌýmay check the status of your application via your

To complete the application and supporting documents, you will need to provide the following documentation. Please note that the privilege requirements mentioned apply exclusively to hospital applications.

·ÌýÌýÌýÌýÌýÌýÌýÌý All professional licenses in California and other states

·ÌýÌýÌýÌýÌýÌýÌýÌý Pocket license/wall certificate of your California state license.

·ÌýÌýÌýÌýÌýÌýÌýÌý Controlled substance certificate issued by PAB approved vendor, showing your PAÌý license number (for PAs only)

·ÌýÌýÌýÌýÌýÌýÌýÌý Furnishing license with Controlled Substance II designation (for NPs only)

·ÌýÌýÌýÌýÌýÌýÌýÌý DEA certificate (full schedule, paid status with a California address)

·ÌýÌýÌýÌýÌýÌýÌýÌý Copy of X-ray/fluoroscopy certificate (as required for privileges)

·ÌýÌýÌýÌýÌýÌýÌýÌý Curriculum Vitae or Resume covering your work history for the last five years (dates must be in mm/yyyy format with from-thru dates)

·ÌýÌýÌýÌýÌýÌýÌýÌý Gap explanation for CV gaps of 90-days or more

·ÌýÌýÌýÌýÌýÌýÌýÌý 2x2 JPG color photo of your face (not required for Affinity-IPA applicants)

·ÌýÌýÌýÌýÌýÌýÌýÌý Current/valid state issued photo ID.Ìý Must be issued by a US state, ie not federalÌý government, can be driver’s license or ID card.Ìý (Not required for Affinity-IPA applicants.)

·ÌýÌýÌýÌýÌýÌýÌýÌý Wall certificate of your degree/diploma (for APP/AHPs)

·ÌýÌýÌýÌýÌýÌýÌýÌý Wall certificate of your Residency and/or Fellowship training programs (if not yet board certified – for Physicians/Podiatrists only).

·ÌýÌýÌýÌýÌýÌýÌýÌý Name, email address and phone number of three (3) references who can comment on your clinical work in the last two (2) years. (For APP/AHPs one must be a supervising physician and 2 additional peers, for Physicians/Podiatrists/Psychologists/Dentists, etc. one must be a Program Director if new graduate or current Chief and 2 additional peers)

·ÌýÌýÌýÌýÌýÌýÌýÌý Malpractice Insurance coverage for the last five years (need policy numbers and Ìýdates of coverage).Ìý You may be asked to provide Certificate of Insurances as well.

·ÌýÌýÌýÌýÌýÌýÌýÌý ACLS/APLS/BLS/PALS by American Heart Association (as required for privileges).

·ÌýÌýÌýÌýÌýÌýÌýÌý ATLS/ENLS/NPR (as required for privileges).

·ÌýÌýÌýÌýÌýÌýÌýÌý Additional items as required for privileges, which can be case logs, letters, documentation of training, etc (determined by privilege criteria on privilege form(s) you complete).

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Once we receive your application..

One of our Credentialing Assistants will reach out to you to gather the necessary documents and facilitate access required to complete your Government Payer applications (Medi-Cal, Medicare and CCS).Ìý

Additionally, a Credentialing Coordinator will contact you to collect any documents, clarifications, or additional information needed for your privileging and/or credentialing applications.

Upon completion, your applications, they will be passed to your assigned Medical Staff Coordinator for final processing and required approval routing (i.e.Ìý Service Chief, Interdisciplinary Practice Committee, Credentials Committee, Medical Executive Committee, Governing Board).Ìý Once your application has been approved by the governing bodies, your Medical Staff Coordinator will notify you by way of a governing board approval letter sent by email (not applicable to Affinity-IPA applicants who should reach out to Affinity directly).Ìý

Please note: for ÌÇÐÄ´«Ã½ and Stanford Tri-Valley applicants, you will need to complete all Epic Education modules loaded for you in your HealthStream account before you will be given Epic access.Ìý If you have any questions how to access the Epic training modules in HealthStream, please do not hesitate to contact your Medical Staff Coordinator assigned to your specialty.Ìý You can find a list of Medical Staff Coordinators here:Ìý /health-care-professionals/medical-staff/contact-us/credentialing-coordinators-directory.html