professional relationships with patients, families, and other members of health care teams; and
( f) recognition of the importance of, and willingness to support, a commitment to quality care and recognition that interpersonal skills and collegiality at all levels are essential to the provision of quality patient care.
2. A. 4. Burden of Providing Information:
( a) Individuals seeking appointment, reappointment, or clinical privileges have the burden of producing any and all information deemed adequate by the Hospital for a proper evaluation of current competence, character, ethics, and other qualifications, including assisting the Hospital in obtaining this information, and resolving any doubts about their qualifications. This includes but is not limited to information that may be needed to assist in an appropriate assessment of qualifications for appointment, reappointment, and clinical privileges, such as information from other hospitals, the individual’ s office practice, insurers or managed care organizations, and confidential evaluation forms.
( b) Individuals seeking appointment, reappointment, or clinical privileges have the burden of providing evidence that all the statements made and all information provided by the applicant in support of the application are accurate and complete.
( c) Applicants are responsible for providing a complete application. An application will be complete when:( i) all questions on the application form have been answered, and it is signed and dated;( ii) the privilege delineation form is completed;( iii) all supporting documentation has been supplied( to include at a minimum copies of licenses( unless pending), DEA( unless pending), board certification, and copies of educational diplomas / certificates);( iv) application fees have been paid;( v) all information has been verified from primary sources including adequate responses from references and all information requested from third parties for a proper evaluation;( vi) the Conflict of Interest disclosure is signed and dated; and( vii) the Code of Conduct is signed and dated.
( d) Additionally, if requested, the following may be required: relevant practitioner-specific data as compared to aggregate data and morbidity and mortality data.
( e) An application will become incomplete if the need arises for new, additional, or clarifying information at any time prior to Credentials Committee reviewing the file and making a recommendation. Any application that continues to be incomplete thirty( 30) days after the applicant has been first notified of the additional information required may be deemed to be withdrawn.
4877-0873-6192, v. 3
10