Application for Re-Appointment

Providers will receive their reappointment application via the email address on file with the Medical Staff Office 120 days prior to the expiration of their current term. An incomplete application will result in the loss of your privileges.

Please note if you wish to voluntarily resign your membership and privileges at the end of the current term you will not need to complete the application. Please be sure to notify Medical Staff Services of your resignation.

Step 1: Log in to the Application Module

  • My Apps > Reappointment Application
  • Check all information carefully for completeness and accuracy. The pre-populated information is what is currently on file. This information may be out-dated.
  • "Click to Sign" to open document(s)

Step 2: All sections included in the application MUST BE COMPLETED or your application will be deemed incomplete.

  • Edit each field on the left-hand side
  • Answer all Questions
  • Click "Review Information"
  • Go to "Sign Documents"
  • "Click to Sign" the Reappointment Application
  • TYPE IN YOUR FULL NAME at the bottom of the document
  • 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.).

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