HEALTHCARE MEDICAL STAFF CREDENTIALING & PRIVILEGING CHECKLIST 2026

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--- PRIMARY SOURCE VERIFICATION (PSV) ---
[ ] Medical School Graduation Date
[ ] Diploma or Degree Certificate
[ ] Institution Name
[ ] Verification Status (Verified, Pending, Discrepancy Found)
[ ] Residency Completion Date
[ ] Board Certification Certificate
[ ] Verified Credentials (Medical Degree, Residency Certificate, Fellowship Certificate, Specialty Board Certification)
[ ] Verifying Officer Signature

--- LICENSURE & REGISTRATION AUDIT ---
[ ] Medical License Number
[ ] Issuing State/Jurisdiction (California, New York, Texas, Florida, Other)
[ ] License Issue Date
[ ] License Expiration Date
[ ] Upload Digital Copy of License
[ ] Associated Registrations (DEA Registration, NPI Number Verified, State Controlled Substance Certificate, Specialty Board Certification)

--- PROFESSIONAL BACKGROUND & SANCTIONS CHECK ---
[ ] Date of Background Check Completion
[ ] Sanction Databases Screened (NPDB (National Practitioner Data Bank), OIG (Office of Inspector General) Exclusion List, SAM (System for Award Management), State Medical Board Disciplinary Records)
[ ] Sanction/Disciplinary Action Found? (No Findings, Yes - Active Sanction, Yes - Historical Issue (Cleared))
[ ] Details of Findings or Disciplinary Notes
[ ] Upload Background Screening Report PDF
[ ] Credentialing Officer Attestation

--- CLINICAL COMPETENCY & PEER REVIEW ---
[ ] Date of Last Clinical Competency Assessment
[ ] Verified Clinical Competencies (Surgical Skill Proficiency, Diagnostic Accuracy, Emergency Response Capability, Patient Communication, Adherence to Clinical Protocols)
[ ] Peer Reference Summary Notes
[ ] Uploaded Procedure Logs & Surgical Logs
[ ] Competency Assessment Outcome (Full Privileges Granted, Provisional Privileges, Privileges with Restrictions, Denied)
[ ] Medical Director Review Signature

--- INSURANCE & MALPRACTICE VERIFICATION ---
[ ] Insurance Carrier Name
[ ] Policy Coverage Limit (Per Occurrence)
[ ] Policy Expiration Date
[ ] Policy Type (Claims-made, Occurrence-based)
[ ] Upload Certificate of Insurance (COI)
[ ] Credentialing Officer Verification

--- PRIVILEGING SCOPE & CLINICAL DUTY DEFINITION ---
[ ] Specialty Area (Internal Medicine, Surgery, Pediatrics, Emergency Medicine, Obstetrics & Gynecology, Anesthesiology)
[ ] Authorized Clinical Procedures (Inpatient Procedures, Outpatient Procedures, Emergency Interventions, Diagnostic Imaging, Minor Surgical Procedures)
[ ] Detailed Scope of Practice Description
[ ] Privilege Effective Date
[ ] Privilege Expiration Date
[ ] Medical Director Approval Signature
[ ] Signed Privilege Agreement Document

--- IMMUNIZATION & HEALTH SCREENING COMPLIANCE ---
[ ] Date of Last Tetanus Vaccination
[ ] Date of Last Hepatitis B Vaccination Series Completion
[ ] Date of Most Recent Tuberculosis (TB) Screening
[ ] Required Immunization Immunization Verifications Completed (MMR (Measles, Mumps, Rubella), Varicella (Chickenpox), Hepatitis B, Influenza (Current Season), Tdap (Tetanus, Diphtheria, Pertussis))
[ ] Upload Immunization Records/Lab Results
[ ] Provider Attestation of Health Compliance

--- CREDENTIALING FILE MAINTENANCE & RE-CREDENTIALING SCHEDULE ---
[ ] Last Credentialing Review Date
[ ] Next Re-credentialing Due Date
[ ] Credentialing Status (Active, Pending Verification, Expired, Under Review)
[ ] Digital Credentialing Archive Folder
[ ] Notes on Re-credentialing Discrepancies
[ ] Medical Staff Office Manager Approval

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