Reappointment
The Peoria Medical Society currently provides
re-credentialing/reappointment services for:
Methodist Medical Center of IL,
Graham Health System (Graham Hospital), and
Renal Interventional Center.
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 reappointment process for renewal of
your hospital staff privileges at the facilities you
have requested.
In addition to the forms below you will also
receive a privilege packet from the facility that you
are requesting reappointment. The average processing
time needed to obtain the appropriate verifications
from a properly
completed form with all attachments enclosed is not
less than 30 days. Please remember that a timely
response with the required paperwork from both the
Peoria Medical Society and the hospital(s) will help to
ensure no lapse in hospital staff privileges.
There will be additional steps required by each
hospital, which will add to the overall processing time.
Per hospital contracts the Peoria Medical Society, has
the responsibility to carefully verify all information
contained on the State of Illinois Re-credentialing Form
directly with the source/institution.
If you have any
questions please contact the office at 309-692-1192.
| Reappointment Consent Form |
| File Size: | 24 kb |
| File Type: | doc |
Download File
| Department Chair Contact Information Form |
| File Size: | 26 kb |
| File Type: | doc |
Download File
| IDPH Recredentialing/Reappointment Form |
| File Size: | 606 kb |
| File Type: | doc |
Download File
| Graham Reappointment Cover Instruction Letter |
| File Size: | 84 kb |
| File Type: | doc |
Download File
| Confidentiality Agreement Reappointment Consent |
| File Size: | 27 kb |
| File Type: | doc |
Download File
| Supplemental Reappointment Application Form |
| File Size: | 96 kb |
| File Type: | doc |
Download File
| Methodist 2010 Reappointment Cover Instruction Letter |
| File Size: | 82 kb |
| File Type: | doc |
Download File