Credentialing: Initial Application Process

Welcome!  Thank you for your interest in joining the Medical Staff of Providence Regional Medical Center Everett.  Below you will find all the documents and information you need to begin the initial credentialing process.  If you have any questions, please contact Tami Soderberg at 425.261.3092.  Please return your completed forms to:  PEMC Medical Staff Office, P.O. Box 1147, Everett, WA 98206.

Instructions:

• Initial Application Instructions
• Bylaws, Rules & Regulations
• Appendix A: Clean Application Requirements
• Medical Staff Membership: General Qualifications

Forms to be Completed and Returned:

• Washington Practitioner Application
• Signature Pages
• Applicant's Intended Practice Plan
• Disclosure Statement
• Washington State Patrol Request for Criminal History
• Tuberculosis Symptoms Checklist (if applicable)
• Privilege Explanation Letter:  Email Tami Soderberg with your Specialty and the appropriate privleging forms will be sent back to you.
  

Bylaws, Rules, Regulaions, & Policies Applying to the Medical Staff (required reading):

• Bylaws, Rules & Regulations
• Ethical and Religous Directives
• Mission, Vision, and Core Values
• Code of Conduct
• Immunization Policy
• PPD Testing Policy
• Life Support Training Policy