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CVS
Initial Appointment Application

Initial Appointment Photo
  • Credentials verification for physicians, dentists, independent and dependent allied health practitioners
  • Complete application presented in segmented classification file that meets all accreditation and licensing requirements including TJC, CMS and AAAHC
  • Sample Specialty Specific Clinical Privileges Provided
  • Primary Source Verification of:
    – Employment
    – License to practice and/or certification
       and/or registration
    – ABMS Board Certification
    – Medical School Graduation
    – Education for Foreign Medical Graduates
    – Internship Residency and Fellowship
       Completion
    – Hospital Affiliations
    – Malpractice Insurance Claims History
    – National Practitioner Data Bank (NPDB)
       Proactive Disclosure Service Enrollment
    – Sanctions Against Licensure
    – Medicare/Medicaid Sanctions
    – Professional References

All Data is stored electronically and reproducible in a secured database available for retrieval.

550 N. 159th East, Suite 219 • Wichita, KS 67230
© 2011 Medical Staff Services Inc.