CREDENTIALING
This site provides the forms necessary to facilitate your credentialing process. The College of Medicine/Department of Medicine will be coordinating this process with your Section. Your credentialing forms will then be forwarded to the Medical Staff Services Office of the University Hospital for review and verification of your credentials prior to forwarding to the Hospital Director for final approval. Also available is a copy of the "Medical Staff Bylaws", "Department Bylaws" with "Billing, Coding & Documentation Guideline" as well as the "UIC Faculty Handbook". These are for your own reference.
Forms required for you to complete and sign are to the right. These may be completed electronically by clicking on each form numbered 1 thru 8. Refer to the "Checklist for New Application" as well as "License Information" to guide you. Be sure to forward all completed forms electronically to the departments Medical Staff Liaison (MSL) at monaoc@uic.edu .
NOTE: As only original signatures are accepted, please print signature pages and mail the original hard copy to the department MSL at 840 S. Wood Street (MC787) , Chicago , IL 60612 . It is recommended that you save a copy for your files and future use as re-credentialing is required every two years.
In addition, you must provide copies of the following: Current dated CV, all current state licenses, Controlled substance certificate and DEA (with IL address), proof of professional liability insurance ($1M/$3M) and explanation of loss history, Medical School diploma/ECFMG certificate (if applicable), Residency certification, Post graduate training certificates, Copy of your board certification and/or qualification letter and NPI verification letter.
Approval of hospital appointments typically takes between 60 to 90 days. The packet must be fully completed and all documents (licenses, etc.) received prior to your start date or your start date will be delayed. You will not be able to see patients until your credentials have been reviewed and approved by the University Hospital Medical Staff Committee. Return the completed packet by e-mailing as an attachment as well as providing hard copies of the requested documentation as soon as possible.
Concerning letters of recommendation, please note that original letters of recommendation should come from faculty holding the same or higher rank than that for which you are being proposed. One letter should be from a supervisor. Original signed recommendation letters should be addressed to: Thomas J. Layden, MD , Professor and Head, UIC Department of Medicine (MC787), 840 S. Wood Street , Chicago , IL 60612 .
If you have any questions about the forms or other requirements, please feel free to contact our office at 312-413-8687.
It is a requirement of University Faculty Affairs to provide a copy of the "Faculty handbook" to all new applicants who apply for medical staff privileges. Please refer to the following URL: http://www.uic.edu/depts/oaa/fachandbook/
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License Information
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Clinical Privileges Form
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MSP Participation
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Pg. 2 Credentialing Application
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Medical Staff Rules & RegulationsMedicare Guidelines