Credentialing Resource Center's Top Tools and Forms of 2018

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Credentialing Resource Center's Top Tools and Forms of 2018

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Credentialing Resource Center’s Top Tools and Forms of 2018

Reviewed by: Jodie M. Chant, MPA/HCA, BHSA, CPCS, RHIT

Credentialing Resource Center’s Top Tools and Forms of 2018 offers medical staff and credentialing professionals the forms, policies, and spreadsheets they need to standardize their activities and make day-to-day operations more efficient.

Each of these handpicked forms was reviewed by CRC Tools and Forms Committee member Jodie Chant, saving MSPs the time and hassle of creating them from scratch. Plus, insightful commentary from Chant is interspersed throughout the forms to help MSPs apply these resources to their day-to-day work.

In addition to the hard-copy forms, each form is also available to download, so you can customize the material to meet your facility’s needs. 


  • Expertise you can rely on: Each of these 50 tools was reviewed and approved by CRC Tools and Forms Committee member Jodie Chant.
  • Save time: This book provides a one-stop alternative to researching one-off sample forms and developing materials from scratch.
  • 100% customizable: In addition to hard-copy forms and guidance, book purchasers get downloadable, customizable versions of each featured form.

Published: December, 2018

Dimensions: 8.5 x 11
Page count: 106

ISBN: 978-1-68308-823-3

Table of Contents

1. Refer and follow/community physician privileges 
2. APRN privileging form 
3. OPPE: Low-volume practitioner reappointment 
4. Physician credentialing file checklist for ambulatory facilities 
5. Practitioner credentials file audit tool/worksheet 
6. Quick reference: Medical staff membership qualifications 
7. Medical staff credentialing and privileging policy for moderate sedation 
8. New procedure or treatment request form 
9. Policy and procedure: Monitoring Medicare/Medicaid sanctions and state sanctions or limitations on licensure 
10. Departmental guidelines for evaluating hospitalists’ performance 
11. Hospitalist performance evaluation 
12. Physician assistant performance evaluation 
13. Bylaws for telemedicine privileges 
14. MSP competencies 
15. Orientation feedback survey 
16. H&P privilege language 
17. Medical staff meeting agenda 
18. Medical staff meeting minutes 
19. Software project dashboard 
20. Credentialing application tips 
21. Telemedicine credentialing policy 
22. CVO employee recognition program 
23. CVO remote work policy 
24. Definitions of care warranting temporary privileges 
25. Bylaws for granting temporary privileges 
26. Temporary privileges policy 
27. Employee newsletter 
28. Bylaws for conflicts of interest 
29. Clinical privileges delineation policy 
30. Core privileges checklist 
31. Aging practitioners physical assessment policy and procedure 
32. Allied health professional competency evaluation 
33. Application checklist for initial appointments and reappointments 
34. Background checks for practitioners policy 
35. Clinical references policy 
36. Conflict of interest form 
37. Credentials file retention policy 
38. Tool for evaluating medical staff committees 
39. FPPE procedure proctoring 
40. FPPE/OPPE quality proctor review form 
41. Medical staff performance expectations: Sample framework and document 
42. OPPE for physician assistant—surgical 
43. OPPE indicator proposal sheet 
44. Organizationwide conflict of interest policy 
45. Physician assistant pediatric clinical privileges 
46. Peer review screening 
47. Physician health committee policy 
48. Professional peer review reference form 
49. Provider enrollment workflow 
50. Retroactive chart review 
51. Surgical monitoring report form 
52. Temporary privileges request form

About the Author

Jodie M. Chant, MPA/HCA, BHSA, CPCS, RHIT, is president and principal consultant of Jodie Chant Consulting, LLC/Chant Medical Staff Resources. Chant possesses 20 years of healthcare experience, including 18 years in administrative healthcare leadership in the acute care, managed care, and physician hospital settings. She recently served as health system director of medical staff services and performance improvement for a large healthcare system in Michigan, directing centralized credentialing operations for five hospitals and a health plan, medical staff accreditation and regulatory compliance, criteria-based privileging, medical staff peer review, institutional mortality review, and all aspects of focused and ongoing professional practice evaluation (FPPE/OPPE). Chant also has experience in health information management, credentialing software development, provider enrollment, and network management.