Appointment/ Reappointment Requirements

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]edu.

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 Clearance

  • Medical Staff/Allied Health Professional Tuberculosis-Screening (TB)
    • All healthcare providers undergoing initial or reappointment credentialing must complete TB screening AND submit a TB questionnaire.  Access the questionnaire via this LINK.
    • If you need to make an appointment for a TB test, please contact Occupational Health: 
    • INITIAL APPLICANTS: You must be officially hired by your department AND be issued a UCLA ID Badge prior to making a TB appointment.  You will be asked to show your UCLA Badge at your appointment.  You may also submit recent TB results (within one year from the time of application) from a non-UCLA facility. 
    • When available, fax BOTH your questionnaire and TB/Quantiferon results to (424) 291-4443, Attn: Credentialing Verification Office, OR email to: [email protected]  You may also upload both within your online application.
    • NOTE:  This TB Requirement also applies to Community (Courtesy) physicians who are not UCLA employees. 
    • For questions regarding TB clearance, contact Occupational Health at 310-825-6771.
  • 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].