Hospital Ancillary Credentialing and Re-Credentialing

List of Hospital Credentialing Expiration of Privileges (Updated as of 08/20/2014)
The next scheduled meeting takes place on September 17, 2014.

Instructions

Accessing the credentialing forms

PDF: Open the application (Adobe Reader required), print and use as a blank form to be completed by hand or typewriter. Type or print legibly in blue or black ink. Once the application is complete, you may photocopy and submit the original with a signed attestation to each privilege to which you wish to apply.

Completing the Forms

  • When completing the employment section, please only list healthcare related employment.
  • Complete each section thoroughly and truthfully, and complete all fields. If an item is not applicable, indicate N/A.
  • You are responsible for providing current information at all times and to update substantial changes throughout the credentialing period. Please remember that you must sign and date a new attestation page each time your form is submitted.
  • Modification to the wording and format of the form will invalidate the application.
  • Attach additional sheets where necessary. (Indicate clearly the applicant's name on each attachment.)
  • Be sure to include the appropriate signatures.
  • Your application for privileges cannot be processed without this form's completion in its entirety. Please remember that it is the applicant's ultimate responsibility to ensure that all information has been received.
  • Double sided documents will not be accepted and applications will be returned.

Submitting the Forms

Submit the following to Cabell Huntington Hospital:

  1. Credentialing or Re-credentialing Form
  2. CHH Addendum - Hospital Required Information
  3. Additional required documents and/or items listed in CHH Addendum and criteria

Send the original, completed application and accompanying documentation to:

Attn: Ancillary Credentialing
Cabell Huntington Hospital
1340 Hal Greer Boulevard
Huntington, WV 25701

It will take approximately thirty to sixty days for approval. You will be notified.

Hospital Ancillary Credentialing Forms

All non-Cabell Huntington Hospital employees are required to accomplish the following:

Application/Reapplication

Criteria Documents

Title 
Arterial Puncture (ABG)Download
AudiologistDownload
Clinical Instructor (Non-Contractual)Download
Dental AssistantDownload
Emergency Insertion LMA-Fastrach (Hospital Employees)Download
Emergency Intubation (EI)Download
Emergency Release of Pleural Air by Needle AspirationDownload
FEESDownload
Hospice NurseDownload
Intraosseous InfusionDownload
Pain Management NurseDownload
Peripherally Inserted Central CatheterDownload
Private First AssistantDownload
Private Scrub NurseDownload
Professional Educator and Employees of Outside AgenciesDownload
Research Assistant/Study CoordinatorDownload
Social Workers/Counselors/Rehabilitation CounselorsDownload
Stand-alone PrivilegesDownload
Umbilical Artery/Vein Catheter InsertionDownload
  • Last updated: 08/22/2014
  • Share |

Watch Video

View more videos