Thank you for your interest in joining the Medical Staff of The Children's Hospital of Philadelphia. We are pleased to offer our providers this secure and easy-to-use on-line application tool and document review as a way to reduce the time you spend manually completing applications and to accelerate the credentialing process. We hope you find this tool helpful in preparing a complete and thorough application.
To complete your application, follow these steps:
1. Review the Documents and Forms
2. Complete the Online Application. Use the login information contained in the letter you received from Medical Staff Affairs. Note: Internet Explorer 6 or above is required.
Please reference your welcome letter for more specific instructions on completing the Online Application.
To expedite entering your information, we recommend that you have quick access to the following documents:
- Training/Education Diploma/Certificates
- Curriculum Vitae, Board Certification Certificate
- State License, State CDS License
- Drug Enforcement Registration Certificate
- ECFMG Certificate, Malpractice Certificate
- Payer Name and Provider # for payers you are currently participating with
3. Send your completed, signed and dated application with attachments to:
The Children's Hospital of Philadelphia
Office of Medical Staff Affairs, CHOP North, Suite 1220
34th Street & Civic Center Blvd
Philadelphia, PA 19104-4399
Be sure to include copies of the following:
- Current CV
- Recent Passport Size Photo
- Completed Clinical Privilege Form
- Signed Medical Assistance Certification Statement
- Medical School Diploma
- For International Medical School Graduates copy of ECFMG certificate
- Internship, Residency, Fellowship/other post graduate training certificates.
- Board Certification Certificate
- Special training certificates (e.g. laser surgery)
- Proof of clinical competence for the past two years (e.g. QA/QI data)
- Continuing Medical Education Certificates for the past two years
- Copy of all current licenses to practice medicine
- DEA Registration in each state you practice
- Current State Controlled Substances Certificate
- Current malpractice Certificate
- Explanation of any malpractice claims/suits during the past five years
- Explanation of any questions answered in the affirmative in the Professional/Health Status sections of the application.
- Explanation of gaps of time between medical school and this application for staff privileges.
- Application fee of $200.00, made payable to The Children's Hospital of Philadelphia.