Credentialing Portal
https://credentialingforms.com
Required Forms:
• Application from the “Anesthesia” link
• Application for Appointment to the Medical Staff
• Request for Approval of Clinical Privileges
• Consent and Release of Information
Required Documents:
• Current CV
• State medical license
• Board certification
• Proof of malpractice insurance
• Two personal references
• Hospital affiliation/reference
• Health status documentation
• Current flu vaccine proof
• COVID-19 vaccination card
• Driver’s license (front and back)
• Medical diploma
Additional Credentials:
• ACLS
• BLS
• NBCRNA card (if CRNA)
• CAQH number
• NPI number
• DEA number
• Social Security number
Submission Guidelines:
• Complete both Anesthesia and Medical Staff sections
• Use photocopies only
• Files must be legible
• Accepted formats: PDF or JPEG