Section IV - Continuing Medical Education
Hospitals use CME as indirect evidence of competence for granting of clinical privileges. If you are applying for clinical privileges, you must indicate the nature and number of hours of all medical/professional education. NOTE: CME log is waived for those now completing or who have completed residency or fellowship within the past 24 months.
A typed/printed log may be substituted for this form providing all the elements of the required information are present and the log is dated and signed.
Signature:
Applicant Name:
Date:
- Pre-Application Questions Completed
- Basic Details In Progress
- Clinical Work History Missing Info
- Education Completed
- CME Not Started
- Licenses Not Started
- Certifications Not Started
- Professional Liability Insurance Not Started
- Claims History Not Started
- References Not Started
- Attetation Questions Not Started
- Background Check Not Started
- Acknowledgments Not Started
- Confidentiality Agreement Not Started
- Information Release Not Started