All new applicants MUST submit a pre-application and be approved prior to submitting a full application.
Both initial and reappointment applicants (except COMMUNITY BASED reappointment) must submit the following documents (allow 8 weeks for processing):
1. 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.
A previously completed CO state application with an "Effective" date of 2011 (see bottom of each page) or later, updated and re-signed is acceptable.
2. Privilege request form and all required documentation described therein:
Allied Health Professional
Note: if requesting any of the following, see additional Privilege Criteria: Bronchial Thermoplasty, Fluoroscopy, Laparascopic & Hysteroscopic Morcellation, Port Access Catheter Placement, Robotic Surgery, Moderate Sedation, Transoral Incisionless Fundoplication, Uterine Prolapse Procedures, Ventilator Management or Xtreme Lateral Interbody Fusion (XLIF).
3. Addenda and all required documentation described therein (checklist included for your convenience):
If 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
COPIC Points Program
COPIC Education for opportunities and points balance (username and password needed)
Community-based reappointment applicants need only submit this application.
Send completed applications to:
BCH Medical Staff Department
P.O. Box 9019
Boulder, CO 80301-9019
Medical Staff Sponsored Students
A school affiliation agreement must be in place to participate in a BCH medical staff sponsored rotation at a BCH facility. An application must also be completed, signed, and submitted to the medical staff office along with all described supporting documentation.