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Credentialing Primary Source Verification Directory

Visit our sister website for credentials verification help!

Member Privileging Forms

This page contains sample privileging forms submitted by fellow CRC subscribers at hospitals nationwide. The forms are representative of a range of medical specialty areas, procedures and new technologies, and allied health professional disciplines. New forms are added monthly.

Query verification checklist
Radiology practitioner assistant
Laser lead extraction
Cryosurgery (kidney)
Cryosurgery (kidney)
Cryosurgery (prostate)
Request for additional privileges
Pathology assistant
Credentialing of Non-Anesthesiologists for use of Anesthetic/Analgesic Agents
Dermatology
Dermatology (other)
Endocrinology
Colon and rectal surgery
Colon and rectal surgery (other)
Sexual assault nurse examiner
Cardiac CT Privileging Criteria
Biventricular Implantable Pacemakers for Cardiologists
Applicant Photo Verification Form
Practitioner Photo Identity Verification Form
Emergency Medicine (Fast Track Only)
Oncology
Aortic aneurysms repair
Gastroenterology
Balloon Kyphoplasty
Pediatric Cardiology
Moderate sedation
Obstetrics
Pain Management
Bariatric Surgery
Carotid Artery Stent or Angioplasty
Internal Medicine
Physical & Rehabilitation Medicine

Free Privileging Forms

Physical & Rehabilitation Medicine

Effective Peer Review

Create a peer review program that does more than meet regulatory standards. This edition explains the connection between peer review, OPPE, and FPPE.

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