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Physician Recruitment
About Columbia
Physician Benefits

Recruitment Forms

The following information will be required in order to complete the credentialing and privileging process:

Peer References (3) (MS Word file)
Hospital Verification Form (MS Word file)
Standardized Credentialing Form (MS Word file)
Current CV (it must be dated)
Missouri license (online application)
BNDD license (online application)
DEA license (online application)
Medical school diploma
Residency completion certificate
ECFMG (Educational Commission for Foreign Medical Graduates)
Board certification
Privileges Application with University Hospital and Clinics
Privilege Delineation Form
Proof of 25 CME credits for each of the last two calendar years
Access and Confidentiality Agreement
Medicare Penalty Statement
Tricare Penalty Statement
Staff Health form on up-to-date immunizations
Proof of faculty screening by Staff Health
Pharmacy signature card
Conscious sedation privilege form
Collaborative Practice Agreements (if applicable)

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