Application for Initial Appointment
To complete the Initial Application you will need to access the Provider Navigator Portal Link below. You will need to enter your User Name (e.g., your email address) and password you established for your Pre-Application. Due to the time-sensitivity of this information and levels of approval, it is imperative that you submit your Initial Application, along with all supporting documents, within 15 days to avoid potential delays in your scheduled start date. If we do not receive the application and all supporting documents within 15 days, your packet is considered incomplete and a new start date will be requested.
Step 1: Log in to the Application Module
- Select "Save & Continue" throughout the process.
- Click on the Resources Tab > Documentation Library for documents that may be required to supplement your application
- Check all information carefully for completeness and accuracy. Your application will be pre-populated with the information provided on your Pre-Application.
Step 2: Please complete all information/fields.
- My Apps > Initial Application - Address each field on the left-hand side
- Health Status - input your TB and Flu (documentation required)
- Additional instructions may appear on the top of the screen as you proceed through the application. Please follow these carefully.
- Any fields marked with a red * is a required field. You must fill out this field before you can leave this page.
- When searching for institutions; if you cannot find the item in the table, choose “INSTITUTION NOT PRESENT”. Please type in the institution name in the comments field of that section.
- Entering the Zip Code first will auto-populate the City and State.
- Use the Upload button where available to attach supporting documentation.
- ALL areas of the application MUST be completed, or the application may be deemed incomplete. If a change to the application is made after it has been signed and submitted, as with any legal document, the application must be resigned and resubmitted after the change has been made.
- Click "Review Information"
- Go to "Sign Documents"
- "Click to Sign" to open each document
- TYPE IN YOUR FULL NAME at the bottom of the document
- Click "Sign Application"
- Click "SUBMIT" once all documents are signed
PRIVILEGES SECTION: Indicate your desired privileges by checking the appropriate areas on the privileges form. You may request privileges in all areas for which you have requisite qualifications (e.g., education, training, experience, etc.).