Initial Applicants

Initial Applicants

Apply

Applications must be completed and submitted within 30 days of receiving initial link when provider applies for privileges. 

Application fee required with initial application. (Effective 2.28.22)

Fee-$400 Physician

Fee-$200 Allied Health 


PLEASE NOTE THE FOLLOWING:

Workstation requirements for Practitioner Home Page use:

  1. Microsoft Internet Explorer Web Browser versions 6-10 or Safari version 5.0 or higher
  2. Screen resolution 1024 x 768 pixels or higher
  3. Adobe Reader 7.0 or higher

 Users of Safari before 5.0, Firefox, Netscape, AOL, Opera, or other unusual environments such as Linux or VMWare may still encounter problems, and should instead use a workstation equipped with supported software meeting the requirements described above.

Please note that a recent update to Google Chrome, version 37.0.2062.124, has resulted in Chrome displaying the message "Undefined" when submitting a form using Chrome when any required fields on the form need to be filled. If you encounter this message, please carefully review the form and complete any required fields.

Additionally, for this reason, using a computer with IE 9 to complete the forms would be best.

Requirements

Information required to receive initial application:

1. Copy of CV

2. Complete Pre-Application request form (link on left):

3. Send both the CV and Pre-Application form to:  credentialing@foundationhealth.org

Medical Staff Services will email link to access application once information listed above is received. Documents you will find on the website listed below:

1. Application form 

2. Privilege Form(s)

3. Consent Form

4. Pre-Check Release Form

All required documents must be submitted for initial application process to begin.

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Practitioner Home Page (PHP): https://fmhmedicalstaffoffice.foundationhealth.org/practitionerhomepage/navigate_main.aspx

FMH Orientation: /med_staff/credentialing/orientation/1_fmh_orientation_powerpoint122020ppt

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Practitioner Home Page (PHP)

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Pre-Application Request Form: https://www.foundationhealth.org/fmh/medical_staff_services/medical_staff_resources/medical_staff_resources_documents/initial_application_forms/pre_application_request_form_finalpdf

Privilege Forms: /med_staff/medical_staff_services/medical_staff_resources/medical_staff_resources_documents/privilege_forms

Credential Application Forms: /med_staff/medical_staff_services/medical_staff_resources/medical_staff_resources_documents/initial_application_forms

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Forms

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