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Apply For Membership

This page provides information to help physicians and allied health professionals apply for membership and clinical privileges at Children's Hospital and Regional Medical Center, and supplements the application packet with additional information.

Minimum Qualifications

  1. To be a member of the Medical Staff of Children's Hospital and Regional Medical Center, an individual must be:
    1. A graduate of a recognized school of medicine, dental medicine, osteopathy, psychology, or other applicable professional programs
    2. Legally licensed to practice in the state of Washington
    3. Practicing in Seattle or within a reasonable distance from the Hospital
    4. Especially interested, involved and qualified in the care of children
    5. Protected by professional liability insurance in the amount required by the Hospital and with an insurer acceptable to the Hospital
  2. Medical Staff members (other than House Staff) must be qualified for, or meet the requirements of the American Board of Medical Specialties of the American Medical Association, or equivalent requirements of the American Dental Association, or of another appropriate professional association or society.

Allied Health Professional Staff

Nurse practitioners and physician assistants that work at Children's, are generally employees of the Hospital, and are required to complete the application process for both Children's employment and membership in the Allied Health Professional staff.

Application Process

The process begins when a request for an application is received from either the provider or a department of Children's Hospital.

Please contact Medical Staff Services for an application packet. Application packets will be sent out within 1 working day of the request and must be returned within 7 days of receipt.

Late applications may delay final approval and affect your ability to work at Children's.

Application Packet Contents

Complete and Sign

  • Washington Practitioner Application
  • Children's Obligations page
  • Privilege form
  • Authorization to Release Information
  • Washington State Patrol Criminal History Background Check form
  • Children's Disclosure Statement
  • Children's Confidentiality Agreement
  • Immunization Requirements (DOC) and Medical Information Release
  • Medicaid and Medicare Notification Acknowledgement
  • DEA Waiver form (where applicable)
  • Pharmacy Signature form (where applicable)

For Review Only

  • Medical Staff Guiding Principles
  • Children's Privacy Handbook
  • Medical Staff Bylaws, Rules and Regulations

Responsibilities of Applicants

  1. Complete the written application. All entries and attachments must be legible, understandable, and substantively responsive on every point of inquiry.
  2. Ensure that the application is accurate and complete by informing Medical Staff Services, in writing, of any change in the information provided or new information that might have an effect on candidacy.
  3. Disclose previously successful and currently pending challenges to any licensure or registration (state or district, Drug Enforcement Administration) or the voluntary relinquishment of any licensure or registration.
  4. Disclose voluntary or involuntary termination of Medical or Allied Health staff membership, or voluntary or involuntary limitation, reduction, or loss of clinical privileges at another health care organization (e.g. hospitals, health plans, medical group).
  5. Disclose involvement in any professional liability action, which is pending or resolved, and final judgments and settlements if the action is resolved.
  6. Provide supporting documentation as outlined on the privilege forms.
  7. Provide additional information as necessary or requested.
  8. Return all paperwork within the required time frames.

What You Can Expect From Children's

Once all required documentation has been submitted and verified, the application will be sent through the Children's approval process.

Applicants will be notified of the Board of Trustees' final decision regarding membership and clinical privileges. The process typically takes less than 60 days.

We will notify you when your completed documents have been received by our office, and again when the application is ready to route for final decision making. You will receive a letter from the Board of Trustees when a final decision is made regarding your application and acceptance on Children's Medical or Allied Health staff.

You have the right to review your credentials file. Please contact the Medical Staff Services manager at (206) 987-5216 to arrange a time for review.

You will also be notified within 5 business days if discrepancies are noted between information you have provided and that which was received through our primary source verification process. You will be asked to provide a written explanation of the discrepancies.

The application process is subject to the requirements of the National Practitioner Data Bank under Title IV of Public Law 99-660, as amended, and stated regulations.

Frequently Asked Questions

If I've already filled out the Washington Practitioner Application (WPA) for another organization, why do I have to complete another application?

Each organization has its own unique credentialing process that meets the organization's patient care needs and the privileges to be granted. In addition to the WPA, each organization may have its own additional forms to complete.

However, you can complete the WPA (DOC) electronically, save it as a Microsoft Word document, and use it for as many organizations as accepts it, updating it as necessary.

Each organization requires an original signature and date, so that page must be printed out and signed/dated for each submission.

What is the difference between the letters of endorsement and the peer recommendations?

The letters of endorsement attest to your overall clinical skills, abilities and professionalism. One of these references should come from your department chief, and two others from physicians who have worked with you for at least six months.

If you are within three years of completing residency, one reference should come from your residency director.

The peer recommendations are more specific, and are intended to be completed by individuals who are knowledgeable of your specific clinical skills.

What privileges should I be requesting?

This question is best answered by your contact person within the department or division to which you are applying. Please feel free to contact him or her directly.

What's the difference between hospital affiliations and work history?

Hospital affiliations are facilities where you currently hold or have held clinical privileges.

Work history includes any other organizations where you have been employed, and where clinical privileges were not required.You do not have to repeat your list of hospital affiliations in the Work History section.

Can I submit an application if I do not currently have a Washington state license or DEA registration?

Yes, you can. Although it is helpful to have them at the time of application, they are required prior to approval. We will verify that information prior to final approval of the application.

Common Errors and Reasons for Delays in the Application Process

  1. Failure to sign or submit all of the required forms within 7 days.
  2. Writing "See CV" on the Washington Practitioner Application, rather than filling it in with complete information.
  3. Inaccurate contact information for educational institutions, peers, hospitals or other work locations and your contact information. Our office does not maintain a current data base of U.S. and foreign health care organizations and providers; therefore, complete and accurate information is required for expedient completion of your application.
  4. Failure to document reasons for gaps in training or work history.
  5. Failure to report all training, including residencies and fellowships, that were not completed.

Resources

Medical Staff Services

Georganna Biggins, CMSC, CPCS
Manager (contact for general/operational questions)
Phone: (206) 987-5216
Fax: (206) 987-5085
E-mail Georganna Biggins

Stacey Opdahl
Credentialing Specialist
Phone: (206) 987-5219
Fax: (206) 987-5085
E-mail Stacey Opdahl

Susan Wardell
Data Specialist (contact for address changes and updates)
Phone: (206) 987-5217
Fax: (206) 987-5085
E-mail Susan Wardell

Mailing Address

Children's Hospital and Regional Medical Center
Medical Staff Services
PO Box 50020 / S-114E
Seattle, WA 98145-5020

Physical Address

6901 Sand Point Way NE
Seattle, WA 98115