To ensure all appointment/reappointment requirements are submitted, follow this link to our checklist: Appointment/Reappointment Requirements Checklist.
Please note the items on this checklist are to accompany your online application submission. ALL items must be completed for your credentialing application to be considered complete.
1) COMPLETE Online Application, including Privilege Form
CME: Submission of actual CME hours are not required. However, a question on the online application will ask you to attest that you have completed the hours required to maintain your medical license, along with a brief listing of the activities. It is also not necessary to record CME hours if you recently completed a Residency or Fellowship. Please indicate on the CME question on the online application: “I recently completed/will complete a Residency/Fellowship program."
Privilege Form: You will request or re-request specific procedural privileges for your department as part of the online application. If you believe the incorrect privilege form was included on the online application, reach out to your medical staff office contact or your Department Chair for more information.
Privilege Categories: Category-A core privileges are generally privileges that require completion of a Residency only. Category B and C privileges generally require advanced training, such as an ACGME accredited Fellowship, board certification, or other advanced training. Should you need more assistance completing your privilege form, contact the Medical Staff liaison for your department. For members already on staff, you may view your current privileges HERE.
SANTA MONICA BACKUP COVERAGE (UCLA-Santa Monica Providers ONLY): You will be asked to list a covering physician on the Santa Monica Backup Coverage. The covering physician is usually a colleague who is willing to provide backup coverage for you. Please contact the UCLA-Santa Monica Medical Staff Office at (424) 259-9531 should you have a question regarding whom to list.
2) Education TRAINING MODULES
UCLA Health requires healthcare providers to complete a number of Training Modules at the time of initial appointment and reappointment. Select each training module link below to begin the training:
*For providers who are applying/reapplying for Venice Family Clinic ONLY, and do not have any other UCLA Health Hospital appointments, ONLY the HIPAA Training Module is required.
If you believe you have recently completed the modules (within the past 12 months), please fax your certificates of completion to (424) 291-4443 or upload directly onto the online application. Your results may not have been registered in the HR system accessed to verify completion of training modules.
For technical support questions pertaining to your education and training modules, please contact the following by email: Cornerstone Help Desk: [email protected].
3) Moderate Sedation Privileges
4) Clinical Activity (Reappointments Only)
5) Provider Health Screening Clearance
6) Job Description/Performance Evaluation (NPs, CRNAs, CNMs Only)
The following items are required when applying for hospital privileges at appointment and reappointment:
7) PA Delegation Agreement (Physician Assistants Only)