Hospital Ancillary Credentialing and Re-Credentialing
| List of Hospital Credentialing Expiration of Privileges (Updated as of 05/16/2013) |
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:
- Credentialing or Re-credentialing Form
- CHH Addendum - Hospital Required Information
- Additional required documents and/or items listed in CHH Addendum and criteria
Send the original, completed application and accompanying documentation to:
Attn: Ancillary CredentialingCabell 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
Important: All non Cabell Huntington Hospital employees are required to take all three tests (see below) and include their answer sheets when submitting the application. A passing score of 80% on each test is required to receive credit for the training.
| HIPAA Training | [ PDF - 143KB ] |
| HIPAA Training Test | [ PDF - 12KB ] |
| MEC Training | [ PDF - 2.4MB ] |
| MEC Training Test | [ PDF - 75KB ] |
| Infection Control Training | [ PDF - 4MB ] |
| Infection Control Test | [ PDF - 344KB ] |
Application/Reapplication
Criteria Documents
| Title | |
|---|---|
| Arterial Puncture (ABG) | Download |
| Audiologist | Download |
| Autopsy Technician | Download |
| Clinical Instructor (Non-Contractual) | Download |
| Clinical Nurse Educator | Download |
| Dental Assistant | Download |
| Dental Hygienist | Download |
| Emergency Insertion LMA-Fastrach (Hospital Employees) | Download |
| Emergency Intubation (EI) | Download |
| Emergency Release of Pleural Air by Needle Aspiration | Download |
| FEES | Download |
| Hospice Nurse | Download |
| Intraosseous Infusion | Download |
| Massage Therapist | Download |
| Pain Management Nurse | Download |
| Peripherally Inserted Central Catheter | Download |
| Private First Assistant | Download |
| Private Scrub Nurse | Download |
| Professional Educator and Employees of Outside Agencies | Download |
| Prosthetist/Orthotist | Download |
| Research Assistant/Study Coordinator | Download |
| RN/LPN Clinic Nurse | Download |
| Social Workers/Counselors/Rehabilitation Counselors | Download |
| Speech Therapist | Download |
| Stand-alone Privileges | Download |
| Umbilical Artery Catheter/Umbilical Vein Catheter Insertion by NICU Nurse | Download |
- Last updated: 05/20/2013
