Thank you for considering joining the medical staff at Saint Mary’s Hospital!

The Medical Staff of St. Mary’s Hospital credentials practitioners in the following disciplines:

Physicians
Dentists
Podiatrists
Psychologists
Advanced Practice Registered Nurses
Certified Registered Nurse Anesthetists
Certified Nurse Midwives
Physician Assistants
Perfusionists

Medical Staff Application Request Form: When you complete and return this form your request will be review by the Chair of the Department granting privileges. Upon primary approval we will send to you via email, fax or mail the full Medical Staff Application.

Should you prefer to print and fax or mail the application request to Saint Mary’s Medical Staff Office, please click on the link below to a PDF version. Please note you will need Acrobat Reader. If you do not have a current version of Acrobat reader please click on the link below.

Download Adobe Reader

PDF version of Application Request

Click here for the Application Request Form

The Medical Staff Application Process

The Medical Staff Application is the document which includes all information necessary for primary source verification for your credentialing and privileges at Saint Mary’s Hospital. Please take care to review and complete the entire form including in your signature upon completion. For all hospitals this form acts as an affidavit indicating the veracity of all statements supporting the granting of privileges.

The credentialing process at Saint Mary’s is efficient and concise. Once your request for application has been reviewed and approved you will be sent a full credentialing packet. When completed, meaning all documents and signatures are included on file and all primary source verification has been fulfilled, your application will be forward to the hospital’s Credentialing Committee for approval. Then over the next two or three weeks reviewed and approved by first the Medical Executive Committee and finally the Hospital Board. In total, the approval process, beginning with the Credentials Committee approval, will take approximately four weeks.

The Credentials Committee currently meets on the third Thursday of the month, and typically credentials are approved on or about the second week of the following month. Using this timeframe as a guide, you will be able to accurately determine a potential date for receipt of your hospital privileges.For more information regarding Physician Relations Services, please contact Mary King, Medical Staff Coordinator at (203) 709-6421 or mking@stmh.org