Medical Staff Services

New Applicants

Welcome new providers! 

All documents required for your NJH application are available on this webpage. Please click each document as applicable to your planned NJH practice, download/save to your computer, complete, and return to your assigned Credentialing Coordinator noted at the bottom of this page.

All documents are set up so you can complete and electronically sign using PDF software, except the Signature Authentication Form, which must be printed and completed by hand. Authenticated digital signatures are required on all other forms requiring such (applied using a password through PDF software). We also accept wet signatures. We cannot accept typed-in or stamped signatures.

 

Checklists (informational only)

• Information that must be disclosed as part of your application
• Required Application Materials Check List

 

Application Forms (all three are required)

• Colorado Health Care Professional Credentials Application
• Consent & Release Form
• Signature Authentication Form

 

Delineation of Privileges Forms

  **Use the form that matches the department and specialty for your NJH practice

 

Advanced Practice Providers

• Advanced Practice Providers (all departments and specialty areas except CRNAs)
• Certified Registered Nurse Anesthetists

 

Department of Medicine

• Allergy & Immunology
• Cardiology
• Gastroenterology
• Hospital & Internal Medicine
• Mycobacterial Respiratory Infections
• Interventional Bronchoscopy
• Neurology
• Occupational Medicine
• Lung Cancer (main campus providers only)
• Pathology
• PhD and PsyD Licensed Psychologists
• Pulmonary, Critical Care, and Sleep Medicine
• Rheumatology and Orthopedics

 

Department of Pediatrics

• Allergy & Immunology
• Behavioral Health
• Cardiology
• Pediatrics (pool moonlighters)
• Pulmonary

 

Department of Radiology

• Radiology

 

Division of Specialty Services

• Anesthesiology
• Cardiothoracic Surgery
• Endocrinology
• General Surgery
• Northern/Western Hematology and Oncology
• Immediate Care Clinic
• Orthopedics
• Otolaryngology

 

Malpractice Insurance Documents

• COPIC Insurance Application (required only for physicians, and only if employed by NJH)
  • Cardiology Supplement (required in addition to main application if you are a Cardiologist)
  • Radiology Supplement (required in addition to main application if you are a Radiologist)

 

NJH Bio Sketch

This form must be completed electronically, meaning please type your information directly into the form you choose, and then submit it to us in an editable format. Use whichever version you prefer. You do not need to complete both versions.

• Fillable PDF version
• Fillable Word version

 

How To Submit Your Application

All new providers outside of NJH should use this secure link to submit their application:

• Secure file drop for Medical Staff Services: https://sftp2.njhealth.org/filedrop/~RbdIfq