INITIAL APPLICATION
To request an initial application, please fill out the form below. Once the request form is submitted, a Silversheet connection request and application will be sent via email to the email address provided on the form.
Initial Application Packets Include:
- Electronic application with consent for release and attestations
- Electronic delineation of privileges/privilege request form
- Peer Review Confidentiality Agreement
- Infection Control & Safety Education
- Injection Safety Competency
Documents to be submitted with your application:
- CV
- Copy of current state license, DEA, and Fluoroscopy/Radiography Certificate (If applicable)
- Professional Liability insurance policy & Certificate of Coverage from insurance carrier (minimum amounts of liability: $1,000,000/$3,000,000)
- ECFMG Certificate (if foreign medical graduate)
- D./D.O./D.D.S./D.P.M./Ph.D. Certificate
- Internship, Residency, Fellowship certificates (if available)
- Evidence of specialty board eligibility status or certificate
- Documentation of CME (min 50 credits x past 2 years)
- Copy of current or most recent hospital privileges
- List of procedures performed during the past 2 years
Application Process:
Initial applications can take up to 60 days to process and complete. Once all verifications and required documents have been received, the application is prepared for Credentials Committee review. The Committee members will then give recommendation to the Board for final approval of privileges on the Peninsula Surgery Center Medical Staff.
When approval has been granted, a letter from the Medical Director and a copy of your approved privileges will be sent via Silversheet and email; physicians/physician assistants may then begin scheduling with our Center. All physicians are required to undergo proctoring for their first 6 cases at the Center. An assigned proctor will be appointed to you in your approval letter. It is your responsibility to coordinate with your proctor to attend the cases.
REAPPOINTMENT
Reappointment to the PSC Medical Staff/Allied Health Staff is every 2 years and coincides with state license expirations. The reappointment application is prefilled with the information that was provided at initial appointment. Any updated information will need to be submitted at this time.
Reappointment Packets Include:
- Electronic application with consent for release and attestations
- Electronic delineation of privileges/privilege request form
- Peer Review Confidentiality Agreement
- Copy of current hospital privileges
DOCUMENT MAINTENANCE
All documents, licenses, certificates, etc. can be updated in Silversheet directly or they may be emailed to credentialing@peninsulasurgerycenter.com.
CVO SERVICE:
PSC uses Silversheet’s credentialing software to maintain all Medical Staff/Allied Health Staff files. Physicians/Physician Assistants will have access to this system with their own profiles. Office Managers, or office staff, may be assigned as a delegate on your account to assist with updating and submitting credentials.
Login: https://silversheet.com/sign_in
Blog (includes instructions): http://blog.silversheet.com/
CONTACT INFO:
Phone: 510-494-5625
Fax: 510-790-8916
Email: ARenaud@washosc.com
*All verification/affiliation requests may be sent to the email listed above.
