Physician Application Materials
-
Colorado Health Care Professional Credentialing Application
- Be sure to save the application to your local computer before you start completing it. Otherwise, you will not be able to save your changes or
- A previously completed CO state application with an "Effective" date of 2011 (see bottom of each page) or later, updated and re-signed.
-
Privilege request form and all required documentation described therein.
- If requesting any of the following, see additional Privilege Criteria: Fluoroscopy, Moderate Sedation, or Ventilator Management.
- Addenda and all required documentation described therein (checklist included for your convenience):
Initial Applicants
If you are going to be employed by Boulder Community Health, complete:
- COPIC Liability Insurance Application
- COPIC No Prior Acts agreement
- COPIC 3R's Physician Agreement/Enrollment
- Payer Credentialing Checklist
- W9
See:
- COPIC Points Program
- COPIC Education for opportunities and points balance (username and password needed)
- Reappointment Applicants