Credentialing Checklist
Bold bullet points are documents that need to be submitted with initial application to expedite the hiring process.
- Current Copy of Clinician License(s) (List of any inactive State licenses, if applicable)
- Copy of Accredited Degree, Transcripts or Diploma
- Copy Driver’s License and Social Security Card (Color copies only)
- Copy of completed Physical Form within the last year
- Copy of Board Certification (If applicable)
- Copy of Internship/Residency/Fellowship certificates (If applicable)
- Copy of DEA (If applicable)
- Copy of Malpractice Insurance certificates for the past 2 years (If applicable)
- Copy of ECFMG (If applicable)
- Copy of CME past two years (If applicable)
- Current Life Supports (BLS, ACLS, ATLS, PALS, etc)
- Case log procedures for the past 2 years(If applicable)
- NPDB/NPI Self Query (Instructions on how to do this will be provided)
- Current Photo - Passport size in color
- TB skin test or chest X-ray within last year (Only if positive history, will need proof along with annual questionnaire)
- MMR Immunization records or titer results showing immunity
- Hepatitis B #1, #2, #3
- Tdap Immunization record (Tetanus, Diphtheria, Pertussus)
- Influenza Immunization record
- Voided Check for Direct Deposit