Applications

NOTE: 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.

OR

A previously completed and saved, updated, re-signed application is acceptable.

AND

2. Privilege request form and all required documentation described therein:

Allied Health Professional

OR

Physician 

Note: if requesting any of the following, see additional Privilege Criteria: Bronchial Thermoplasty, Fluoroscopy, Laparascopic & Hysteroscopic Morcellation, Port Access Catheter Placement, Robotic Surgery, Moderate SedationTransoral Incisionless Fundoplication, Uterine Prolapse ProceduresVentilator Management or Xtreme Lateral Interbody Fusion (XLIF).

AND

3. Addenda and all required documentation described therein (checklist included for your convenience):

Initial Applicants

If to be employed by Boulder Community Health,

complete:

COPIC Liability Insurance Application
COPIC No Prior Acts agreement
COPIC 3R's Physician Agreement/Enrollment Form

see:

COPIC Points Program
COPIC Education (opportunities and points balance; username and password needed)

OR

Reappointment Applicants

 

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

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.

Left mouse button enlarges type
Right mouse button decreases type
Eliminate graphics and print content