Allied Health Professional

Instructions:
Please download all of the necessary forms below, complete them in their entirety, sign, and return with all supporting documents to the Peoria Medical Society office to begin the credentialing process for hospital staff privileges at the facilities you have requested.

The average processing time needed to obtain the appropriate verifications from a properly completed form with all attachments enclosed is not less than 45 days. There will be additional steps required by each hospital, which will add to the overall processing time. A completed Form and your timely response to requests for additional information will help expedite this process along. Per hospital contracts the Peoria Medical Society, has the responsibility to carefully verify all information contained on the State of Illinois Form directly with the source/institution. This will include but not be limited to verifying licenses, internshipSection 965s, residency, hospital affiliations, work history and malpractice experience, completing the form in its entirely and providing all requested documents at the time of submission of the application will help to expedite the credentialing process. If you have any questions please contact the office at 309-692-1192.

Instruction Letter
File Size:	148 kb
File Type:	pdf

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Statement of Applicant
File Size:	14 kb
File Type:	pdf

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Addendum to Application
File Size:	20 kb
File Type:	pdf

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Physician's Health Statement
File Size:	18 kb
File Type:	pdf

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Background Release
File Size:	51 kb
File Type:	pdf

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CME Statement Form
File Size:	318 kb
File Type:	pdf

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Request for Additional Information
File Size:	727 kb
File Type:	pdf

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Consent of Release
File Size:	9 kb
File Type:	pdf

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Health Care Credentialing Form
File Size:	835 kb
File Type:	doc

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