Requesting an Application for Allied Staff Membership
Please contact the Medical Staff Office to request an application, referred to as a “Request for Consideration – RFC” for staff membership and clinical privileges for your specific specialty. Contact Carla Ridley, CPCS at (850) 325-5911 or via email email@example.com
You will need to call or email Carla Ridley in order to start the credentialing process. She will then send a pre application to get some basic knowledge such as full legal name, social security number, and National Practitioner Identification number. When you return the pre application to Carla Ridley by fax, email, or in person she will submit this and you should receive the online application through your email within 48 hours. The application fee can be paid by check, please see more about application fees in the Frequently Asked Questions section. Application that do not include the application fee will not be processed until the fee has been received.
Once you have received your application packet, Read Bylaws, HCA Code of Conduct, Mission, Vision and Values Statement. All applicants should thoroughly review these documents prior to requesting staff membership and/or clinical privileges. You will be asked to sign an attestation that you have read and fully understand and agree to comply with the Medical Staff Bylaws, Rules and Regulations, and applicable policies.
Once you have fully completed the Request for Consideration, please submit the application. This will send the paperwork directly to the Credentialing Processing Center in Jacksonville Florida. Please send your supplemental documents to Carla Ridley in the Medical Staff Office. Also keep a copy for your records.
By accepting and completing a Request for Consideration and returning it with the 75 dollar application fee, you acknowledged that you have reviewed and understand the Medical Staff Bylaws, Rules and Regulations, and Code of Conduct. You further agree to be bound by the same, both at the time of application and throughout your appointment and reappointment terms. YOU ARE STRONGLY URGED TO PRINT THESE DOCUMENTS FOR FUTURE REFERENCE AND BE FAMILIAR WITH THEM.