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 Applicationincluding 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.


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

  • INITIAL APPLICANTS: If you are requesting moderate sedation privileges for the first time, follow this LINK to take a moderate sedation quiz.  A certificate of completion is required to be granted this privilege. 
  • REAPPOINTMENTS: For providers undergoing reappointment, documentation of moderate sedation cases OR a certificate of completion of the aforementioned quiz is required for renewal.  If you elect to submit cases rather than take the quiz, reach out to your Medical Staff liaison to obtain a submission form.

4) Clinical Activity (Reappointments Only)

  • Members are expected to submit documentation and meet the criteria for requested privileges.  Please note that you are required to submit documentation of minimum clinical activity for your service area at the time of reappointment.  If you have any questions about the specific activity requirement, please contact your designated Medical Staff Liaison.

5) Provider Health Screening/TB Clearance

Employed Providers: You must have a UCLA ID Badge prior to making a Health Screening/TB appointment as you will be asked to show your badge at your appointment.

Initial: Occupational Health will contact you to schedule an appointment close to your start date. If you have not been contacted for an appointment, please reach out to your HR Onboarding Coordinator for assistance.

Reappointment: Walk-Ins are welcome as no appointment is necessary to obtain a current TB test from UCLA Occupational Health. Please visit Occupational Health to review additional details on how to obtain your TB Screening.

Non-Employed Providers: Submit recent TB results via email to your Medical & Professional Staff Services Representative at the time of initial appointment and reappointment. TB results need to be dated within one year from the time of appointment. Acceptable documentation is the following: 1. Negative Tuberculin Skin Test (TST) or QuantiFERON assay or 2. Chest X-Ray completed within the last 5 years if history of positive test and no current active infection. To locate the contact information for your representative visit our Contact Us page.

COVID-19 Vaccination Compliance: All members of the Medical Staff and Allied Health Professional Staff must demonstrate compliance with the UC-wide COVID-19 Vaccination policy, requiring full vaccination against COVID-19.

6) Job Description/Performance Evaluation (NPs, CRNAs, CNMs Only)

The following items are required when applying for hospital privileges at appointment and reappointment:

  • Nurse Practitioner (NP)
    • Job Description at initial
    • Performance Evaluation at reappointment
  • Certified Registered Nurse Anesthetist (CRNA)
    • Job Description at initial
    • Performance Evaluation at reappointment
  • Certified Nurse Midwife (CNM)
    • Job Description at initial
    • Performance Evaluation at reappointment

7) PA Delegation Agreement (Physician Assistants Only)

  • PA Delegation Agreement at appointment/reappointment
  • Follow this link to access a blank copy of the PA Delegation Agreement: LINK
  • Job Description at initial
  • Performance Evaluation at reappointment


  •  Please email [email protected] or call (310) 794-0440 for further questions.
  •  A confirmation email will be sent to you upon submission of your online application. However, submission of your online application does not constitute completion of the credentialing process. The entire application process is complete when your online application has been submitted AND all additional requirements (TB Questionnaire, Training Modules) noted above have been completed.  For further confirmation, email [email protected].