Thank you for your interest in obtaining privileges at University Hospital/University McDuffie. Attached is the instruction sheet to go to our website and obtain the forms you’ll need to start this process. Both Physician and Allied Health Professional forms are located on the website.

Per the Initial Credentialing Policy, credentialing can take 60 – 90 days to complete.

Once the application is reviewed by the Medical Staff Office we will contact you for any further information we may need. .

Once the applicant’s file has been favorably reviewed by the Credentials Committee the applicant is eligible to schedule EPIC training. The applicant must then contact our IT department to schedule the EPIC training. satisfactory completion of which is required before clinically working at University Hospital/University McDuffie.

The contact information for EPIC training is the physician support team and they can be reached at 706-774-7327 or you can email the .

The applicant after being approved can obtain their ID badge and parking stickers through Security. They can also contact the medical staff office about this as well at 706-774-2165 or .

For Physicians – we also hold new physician orientation. The physician will be called or emailed when those are scheduled so that attendance can be arranged.

If you have any questions you may call 706-774-2165.

Thank you,

Becky Echols, Director, Medical Affairs & Hospital Practices

Revised 12/2015


Instructions for Initial Physician/Initial AHP Credentialing

Step 1 / Go to www.universityhealth.org
Step 2 / Click on For Physicians at bottom of page under Quick Links
Step 3 / Login
User Name: Physician
Password: uhcs
Step 4 / Once logged in, click on Credentialing
On the left hand side - Click on your appropriate category (Physician or AHP) and complete all forms
·  Physician Initial Application
·  Physician Reappointment Application
·  AHP Initial Application
·  AHP Reappointment Application
Step 5 / Mail all forms and Initial Application Fee to:
University Hospital
Medical Staff Office
1350 Walton Way
Augusta, GA 30901
Fax # 706-774-5067


For questions or concerns pertaining to your Initial Credentialing Packet, please contact Sue Bruce at 706-774-2165

UNIVERSITY HOSPITAL/UNIVERSITY MCDUFFIE MEDICAL STAFF

APPLICATION CHECKLIST

Please review the checklist below carefully and assure that items listed are complete and/or attached.

Return the following with the completed application:

$500 Non-refundable Application Fee, payable to University Hospital
Copy of current Georgia State Medical License
Copies of other previous or current Medical License from other states
Copy of current DEA Certificate
Copy of ECFMG, if applicable
Documentation of Visa status, if not a U.S. citizen
Current Curriculum Vitae
CME - Category 1 Information
Copy of Diplomas (Medical school, internship, residency, fellowship, etc.)
Copy of Board Certification(s) or Letter stating status of Board Certification process
Copy of DD214, if discharged from the military
Current Photograph, passport size and quality – No photocopies accepted
Current Clear Copy of Valid Drivers License
CPR or ACLS Certificates
Copy of current PPD Skin Test (test date not to exceed 12 months)
Certificate of Professional Liability Insurance naming University Hospital and/or University McDuffie as certificate holder or letter from insurance company stating application in process

Assure that the following are complete:

Application – Complete all areas, “see resume” or ”see attached” are unacceptable. Sign & date.
Application Part II - Complete all areas, “see resume” or ”see attached” are unacceptable. Sign & date.
Delineation of Privileges Form - Complete as appropriate. Sign & date
University Hospital and/or University McDuffie Bylaws & Rules and Regulations Attestation Form signed & dated
12 months of clinical activity, including approximate number and types of procedures performed with outcomes and location (i.e. hospital, ambulatory surgery center, office, etc.) If you recently completed your residency, you may provide a summary of your residency log.
Performance letter from Residency/Fellowship or Chief of Staff/Department Chair
Background Screening Form
Code of Conduct Policy – signed and dated
Reflex Testing Acknowledgment – signed and dated
Operative/Procedure Site Verification and Time Out Process – Mandatory for all Physicians to Sign & date

L:\common\Application Forms & Applicants\GA Uniform Application\UH Checklist & Attestation Revised 1-2016

***EPIC TRAINING***

Per the Medical Staff Governance:

In order to be granted user access to the electronic medical record, physicians are required to complete EPIC training prior to beginning clinical activity at University Hospital/University McDuffie.

To register for training classes, please contact the physician support team at 706-774-7327 or you can email the .

There are no exceptions to this requirement – this applies to all physicians specialties.

Medical Staff Office, 1350 Walton Way, Augusta, GA 30901-2629