Credentialing Process

Peoria Medical Society

7700 N. Harker Dr.
Suite D
Peoria, IL 61615

Credentialing Process:

A important service provided by the Peoria Medical Society is to verify the credentials of those who wish to obtain privileges in the Peoria area hospitals and other health care facilities. Any questions please call or email Diane or Stephanie.

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.

Health Care Professional Credentialing and Business Data Gathering Form (35 pages)
Instruction Letter - Physicians (2 pages)
Instruction Letter - Allied Health Professionals (3 pages)
Fee Letter (1 page)
Request for Additional Information (3 pages)
Consent for Release (1 page)
Addendum to Application (3 pages)
Statement of Applicant (2 pages)
Kroll Background Release (1 page)
CME Statement form (1 page)
Physician's Health Confirmation Statement (1 page)

Re-appointments, State of Illinois Healthcare Professional Recredentialing Form

Practioners applying at OSF St. Francis Medical Center, please use this link for further information

If you have any questions or problems call the Medical Society (309) 692-1192