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| Category | Documents | Notes |
|---|---|---|
| Application & Forms Specific To Each Organization | Completed Credentialing Application | Usually Mandatory |
| Signed & Currently Dated Attestation & Release Forms | Usually Mandatory | |
| Completed Delineation of Privileges Form | Usually Mandatory | |
| Financial Forms | Completed W-9 Federal Tax Form | Usually Mandatory |
| Authorization for Direct Deposit Form | Usually Mandatory | |
| Education & Training | Current Curriculum Vitae (CV) with full professional history | Avoid gaps; month & year required. Explain any gaps thoroughly |
| Copy of CRNA School Diploma | ||
| Current CME (past 2 years) | Usually Required | |
| Licenses & Certifications | ||
| Copy of NBCRNA Certification | Usually Required | |
| Copy of RN License or APRN License | Usually Required | |
| Copy of Current Federal DEA & State Controlled Substance Registrations | Usually Not Required | |
| Copy of Any: BLS, ACLS, ATLS, PALS, APLS, Certificates | ACLS, BLS usually Required | |
| Insurance & Legal | Certificate of Professional Liability Insurance Coverage | Face sheet or declaration page of policy |
| Documentation for Malpractice/Disciplinary Actions | Court documents or explanation form | |
| Permanent Resident Card, Green Card, or Visa Status | Non-U.S. citizens must provide proof | |
| Military Discharge Record (Form DD-214) | If applicable | |
| References & Clinical History | 3 Written Letters of Recommendation | Must be from providers who observed practice within past year |
| Case Log from Last 24 Months | If applicable | |
| Identification & Miscellaneous | Recent Photograph (Signed & Dated) | Must be signed in the margin |
| Copy of Current Driver’s License or Passport | Usually Required | |
| Copies of Current Immunization Records & Most Recent TB Test Results | If available | |
| Copy of National Provider Identifier (NPI) Documentation & Confirmation Letter | Usually Required. This is public information and can be searched easily. | |
| NPDB Query | If applicable |