( 6 ) current information regarding the applicant ’ s ability to safely and competently exercise the clinical privileges requested ;
( 7 ) a list of all hospitals where the applicant has practiced ;
( 8 ) information from professional training programs including residency and fellowship programs ;
( 9 ) information from the National Practitioner Data Bank ; ( 10 ) other information about adverse credentialing and privileging decisions ; ( 11 ) information from a criminal background check ;
( 12 ) information from any other sources relevant to the qualifications of the applicant to serve on the Medical Staff and / or hold privileges ;
( 13 ) morbidity and mortality data and relevant practitioner-specific data as compared to aggregate data , when available ;
( 14 ) verification of Social Security Death Master File ; and ( 15 ) a copy of a government-issued photo identification .
3 . A . 2 . Misstatements and Omissions :
( a ) Any misstatement in , or omission from , the application , regardless of whether the individual ’ s office staff completed the application or submitted the materials in question , is grounds to stop processing the application . The applicant will be informed in writing of the nature of the misstatement or omission and permitted to provide a written response . The Chair of the Credentials Committee and CMO / VPMA will review the response and determine whether the application should be processed further .
( b ) If appointment has been granted prior to the discovery of a misstatement or omission , the individual will be informed in writing of the nature of the misstatement or omission and permitted to provide a written response . The individual will also have an opportunity to meet with the Chair of the Credentials Committee , CMO / VPMA , and Chief of Staff to explain the misstatement or omission . These individuals will review the response and determine whether appointment and privileges should be deemed to be resigned pursuant to this Manual .
( c ) No action taken pursuant to this Section will entitle the applicant or member to a hearing or appeal .
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