University of Iowa Clinical Staff Office

Physician
Privileging/Credentialing Application Materials

• Standard Delineated Privileges
• Visiting or Observing Physicians
• Temporary Privileges

Standard Delineated Privileges

The following materials must be submitted to apply for privileges/credentialing as a MD or DO at UI Hospitals and Clinics:

• Application Attachment Checklist
• Please see the table below for department specific Iowa Statewide Universal Practitioner Applications.
• Additional Applications can be found on the Other Forms link

Visiting or Observing Physicians

• Familiarize yourself with the Guidelines for Visiting Physicians document.

Temporary Privileges

The following materials must be submitted to apply for Temporary Privileges at UI Hospitals and Clinics:

• Copy of current CV
• Copy of current malpractice cover sheet
• UIHC Temp Application MSWord document (to be printed, filled out and signed)
• UIHC Temp Application Template Part I Part II (to be filled in, then printed for signatures)
• Authorization to Release (included with Temp Application) - Part II
• NPDB Request (included with Temp Application) - Part II

Application Table