Mercy Hospital Medical Staff Credentialing Manual - Mercy Health

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CREDENTIALING MANUAL REVISED AND APPROVED BY THE BOARD OF DIRECTORS JANUARY 24, 2008ADMINISTRATIVE COMPLETIONCredentials Presented :□□□□□Government Issued ID (driver’s license or passport) and Hospital ID BadgeGovernment Issued ID (driver’s license or passport) and Medical LicenseGovernment Issued ID (driver’s license or passport) and DMAT IdentificationGovernment Issued ID (drivers license or passport) and Identification indicating that theindividual has been granted authority to render patient care in emergencycircumstances, with such authority having been granted by a federal, state or municipalgovernmental entityGovernment Issued ID (drivers license or passport) and presents identification by acurrent hospital or medical staff member with personal knowledge regardingpractitioner’s identity volunteer’s ability to act as a licensed independent practitionerduring a disaster;Disaster Privileges Authorized by: _______________________ _____ Title______________Mercy Member Assigned to: ______________________________________________Location Assigned: ____________________________________ Time: _______* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *MEDICAL STAFF PERSONNELCredentials Verified by: __________________________________ Title _______________If unable to verify credentials within 72 hours of disaster, please indicate reason below:________________________________________________________________________________________________________________________________________________________14
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Mercy Hospital Medical Staff Credentialing Manual - Mercy Health

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