Credentialing

The process of obtaining, verifying and assessing the qualification of Licensed independent practitioner to determine whether he or she is qualified and able to provide patient care services in or for a health care organization. The obtain and verify portions of credentialing are mostly administrative in nature and can be performed by a medical staff coordinator. The assessment of qualifications must be done by an Licensed independent practitioner equivalent of the rank of Medical Director / Head of Department. Once credentiated, an applicant can be recommended for appointment to the medical staff.

Privileging
Privileging accompanies credentialing. Privileging is a process by which health care organization authorizes healthcare practitioner to perform specific patient care services related to his specialty. Credentialing and privileging ensures medical quality.

Credential Committee
Members : 1. Managing Trustee 2. CEO 3. Medical Director 4. Senior Medical Advisor

Steps of Credentialing

1. Committee to decide the need of consultant in the particular speciality 2. Doctor seeking attachment to the hospital fills the Credentialing form giving details of his qualification and work experience 3.Medical Director/ Head of Department verify the details from the University/ Medical Council 4. Reference check is also done by communicating with senior professional from whom the candidate is trained.

Benefits of Credentialing
1. Provides efficient and quality patient care. 2. Protects the patient from unqualified practitioner 3. Protects the hospital from accusation of negligence 4. Objective evaluation to provide particular services or to perform particular procedure.

APPLICATION FOR CREDENTIALING

HOSPITAL DATE OF APPLICATION POST APPLIED FOR 1. PERSONAL DETAILS NAME AGE SEX _____________________________ ______________________________ ______________________________ ___________________________________ ____________________________________ ____________________________________ PHOTO

MARITAL STATUS_______________________ NATIONALITY___________________________ PAN CARD NO_____________________________ AREA/ DISCIPLINE / SPECIALTY________________ PERMANENT ADDRESS__________________________________ ________________________________________________________ CORRESPONDENCE ADDRESS____________________________ ________________________________________________________ TELEPHONE : OFFICE ____________ MOBILE____________ EMAIL ID _______________________________ WHETHER PREVIOUSLY APPLIED : IF YES, WHEN YES/NO

_________________________________ ______________________________

REASON FOR REJECTION

2. PROFESSIONAL QUALIFICATION DIPLOMA/DEGREE/ UNIVERSITY/ YEAR OF PERCENTAGE NO OF MASTERS COLLEGE PASSING OF MARKS ATTEMPT

(Please attach certified copies of any qualifications detailed in the form) 3. OTHER TRAINING COURSES TYPE OF TRAINING INSTITUTION DURATION (MONTHS) YEAR

(Please attach certified copies of any training detailed in the form)

4. WORKING EXPERIENCE POSITION HELD INSTITUTION/ DURATION ORGANIZATION YEAR SALARY DRAWN

( If more space is needed, please list on a separate sheet)

5. CONTINUING EDUCATION ( Relevant education seminars, courses, etc attended within last 3 years. Attach document that will support application)

6. REGISTRATION MEDICAL COUNCIL OF INDIA _____________________ MAHARASHTRA MEDICAL/ NURSING/ PHYSIOTHERAPIST/ TECHNICIANS COUNCIL __________________________________

7. PLEASE LIST AT LEAST TWO REFREES FAMILIAR WITH YOUR CLINICAL SKILLS ____________________________________________________________ ____________________________________________________________ 8. ANY MALPRACTISE SUITE IN COURT OF LAW 9. ANY CASE OF MEDICAL NEGLIGENCE YES/ NO YES/NO

I hereby declare that all the information given herein are true and correct

Signature of applicant Date

APPLICATION FOR CLINICAL PRIVILEGES

HOSPITAL DEPARTMENT OF PERSONAL DETAILS NAME AGE SEX

____________________________________ ____________________________________

_____________________________________ _____________________________________ _____________________________________

NATIONALITY _____________________________________ PAN CARD NO _____________________________________ SPECIALITY _____________________________________ ____________________________ _______________________

PERMANENT ADDRESS

CORRESPONDENCE ADDRESS

TELEPHONE : RESIDENCE ___ _________ MOBILE_______ EMAIL ID STAFF POSITION CONSULTANT RESIDENT TECHNICIAN SENIOR RESIDENT NURSING PHYSIOTHERAPIST ____________________________________

2. PROFESSIONAL QUALIFICATION DIPLOMA/DEGREE/ UNIVERSITY/ YEAR OF PERCENTAGE NO OF MASTERS COLLEGE PASSING OF MARKS ATTEMPT

(Please attach certified copies of any qualifications detailed in the form) 3. OTHER TRAINING COURSES TYPE OF TRAINING INSTITUTION DURATION (MONTHS) YEAR

(Please attach certified copies of any training detailed in the form)

4. WORKING EXPERIENCE POSITION HELD INSTITUTION/ DURATION ORGANIZATION YEAR SALARY DRAWN

( If more space is needed, please list on a separate sheet)

5. CONTINUING EDUCATION ( Relevant education seminars, courses, etc attended within last 3 years. Attach document that will support application)

6. REGISTRATION MEDICAL COUNCIL OF INDIA MAHARASHTRA MEDICAL/NURSING/PHYSIOTHERAPIST/TECHNICIANS COUNCIL

7. PLEASE LIST AT LEAST TWO REFREES FAMILIAR WITH YOUR CLINICAL SKILLS

8. ANY MALPRACTISE SUITE IN COURT OF LAW -

YES/ NO

9. ANY CASE OF MEDICAL NEGLIGENCE -

YES/NO

10. REQUEST FOR APPROVAL OF PRIVILEGES

I request approval for the Clinical Privileges indicated below for the period of ______ to ________ ( please indicate date). I certify that the information provided on this application is complete and accurate.

i. Core privileges ( Broad area ) ii. Special privileges ( in area) iii. Others e g. Research

Have the privileges you are requesting been granted to you at your previous place of employment? YES If yes , please specify, NO

I hereby declare that all the information given herein are true and correct

Signature of applicant Date

APPLICATION FOR CLINICAL PRIVILEGES

( Head of Department Recommendation) Our Ref Date Chairperson Hospital Privileging Committee This is to certify that _____________________________ has been employed as _____________________ As the HOD, this person is certified as competent and privileges to perform the procedure as stated below: a) Core Privileges (Broad area e.g. Medicine)

b) Special Privileges (in area)

The education, training and / or experience identified, support this assertion of competence in privileges requested. This education, training and / or experience have been verified with the primary source, see attached.

Signature: ________________

Date: _________

Serial No: _______________________

Application status: Verified and complete Privileges approved from

to (dd / mm / yy) (dd / mm / yy)

________________ Secretary HPC