{"id":1275,"date":"2023-12-05T13:51:00","date_gmt":"2023-12-05T21:51:00","guid":{"rendered":"https:\/\/www.cdcr.ca.gov\/hcdom\/?post_type=dom&#038;p=1275"},"modified":"2025-09-22T11:37:57","modified_gmt":"2025-09-22T18:37:57","slug":"1-4-1-2-licensed-medical-provider-credentialing-and-privileging","status":"publish","type":"dom","link":"https:\/\/www.cdcr.ca.gov\/hcdom\/dom\/chapter-1-health-care-governance-and-administration\/article-4-1-professional-workforce-credentialing-and-privileging\/1-4-1-2-licensed-medical-provider-credentialing-and-privileging\/","title":{"rendered":"1.4.1.2 Licensed Medical Provider Credentialing and Privileging"},"content":{"rendered":"\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p><strong>Policy<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p>California Correctional Health Care Services (CCHCS) shall maintain a process to credential and privilege all licensed medical providers who provide patient care services at California Department of Corrections and Rehabilitation (CDCR) institutions to ensure that they meet minimum credentials, privileging, and performance standards.  Licensed medical providers shall not perform any job duties prior to having their credentials approved nor provide direct patient care until privileges have been granted.  CCHCS considers credentialing and privileging activities to be peer review activities within the meaning of Business and Professions Code, Section 805 and Evidence Code, Section 1157.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p><strong>Purpose<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p>To ensure that all licensed medical providers subject to this policy and who provide patient care services at CDCR institutions meet minimum credentials, privileging, and performance standards.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p><strong>Applicability<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p>This policy and procedure applies to all licensed medical providers. <\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p><strong>Responsibility<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p><strong>Hiring or Contracting Authority<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p>The Hiring or Contracting Authority (HCA) is responsible for ensuring that licensed medical providers are appropriately credentialed and operate within the scope of their clinical privileges.  Prior to submitting a request for credentialing and privileging, the HCA shall ensure that all pre-appointment human resources requirements have been met including, but not limited to, completing Live Scan reviews.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p><strong>Medical Reviewer<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p>The Medical Reviewer (MR) shall review and make a determination regarding all credential and core privileging applications referring to the Medical Peer Review Committee for a recommendation as specified in Referral Criteria (Appendix 4).<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p><strong>Physician Manager<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p>The physician manager is responsible for reviewing requested additional clinical privileges and for making a determination regarding privileging actions and for monitoring and surveillance of the professional competency and clinical performance of those who provide patient care services with delineated clinical privileges.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p><strong>Medical Executive<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p>The medical executive is responsible for coordinating and facilitating the Performance Evaluation Meeting (PEM) where a recommendation regarding advancing provisional privileges to active privileges for newly hired civil service licensed medical providers, including those who are not subject to a probationary period, is made.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p><strong>Local Governing Body<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p>The Local Governing Body (LGB) for each institution or facility where direct patient care services are provided within a licensed unit is responsible for reviewing requested clinical privileges and for making a determination regarding privileging actions.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p><strong>Credentialing and Privileging Support Unit<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p>The Credentialing and Privileging Support Unit (CPSU) shall review and process all applications for credentials and privileges in accordance with this policy and procedure.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p><strong>Medical Peer Review Committee<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>The Medical Peer Review Committee (MPRC) shall review and act on credentialing and privileging application referrals received from the MR.\u00a0 The committee shall monitor credentialing and privileging activities within CCHCS and ensure that program-specific standards for credentials and clinical privileges remain current and up-to-date under applicable legal, accreditation, and community standards.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>The MPRC shall refer all proposed actions that will impact the privileges of a licensed medical provider to the Health Care Executive Committee (HCEC) for approval and further action.  All other actions taken by the MPRC shall be reported to the HCEC on an informational consent item report.  This includes placement of credential alerts and credential bars as well as privilege modifications which are not taken for medical disciplinary cause or reason (i.e., lapse or expiration of credentials or privileges or a failure to secure required certifications or licenses).<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p><strong>Health Care Executive Committee<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p>The HCEC shall oversee the MPRC\u2019s credentialing and privileging activities and shall review all privileging actions taken by the MPRC.\u00a0 The HCEC may act independently as necessary to ensure that patient health care at CCHCS meets the standard of care.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p><strong>Licensed Medical Providers<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Licensed medical providers are responsible for the following items:<\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Providing evidence of licensure, registration, certification and other relevant credentials as set forth in this section for verification prior to appointment and throughout the appointment process as requested.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Notifying CCHCS of information or actions that would adversely affect or otherwise limit their privileges at the earliest date after information is received by the licensed medical provider but no later than 15 calendar days. This includes not only final actions but also pending and proposed actions.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Maintaining licenses, registrations, and certifications in good standing and informing the HCA of any changes in these statuses, including but not limited to, any pending or proposed actions, at the earliest date after notification is received by the licensed medical provider but no later than 15 calendar days.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Obtaining and producing all required information for a proper evaluation of professional competence, character, ethics, and other qualifications.  The information shall be complete and verifiable.  The licensed medical provider has the responsibility for furnishing information that will help resolve any questions concerning these qualifications.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Failure to keep CCHCS fully informed on these matters may result in administrative or disciplinary action.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p><strong>Procedure Overview<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>The credentialing and privileging process includes primary source verifications for credentialing determinations for licensed medical providers.\u00a0 The minimum qualifications reviewed for all providers shall include, but not be limited to, licensure, certification, education, training and experience, competence, and physical and mental ability to discharge patient care responsibilities appropriately in a correctional setting.\u00a0 This includes any information which impacts a provider\u2019s:<\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Clinical skills, competency, and judgment necessary to perform the health care services provided to patients.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Judgement and ability to perform procedures required of any specialty for which credentials are reviewed.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Consistent observance of professional and ethical standards including a history of acting in a professional and collegial manner.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Written and verbal communication skills.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>The CPSU shall work collaboratively with appropriate stakeholders in collecting, reviewing, tracking, and evaluating licensures, relevant training, experience, and competencies of each licensed medical provider.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Credential decisions for licensed medical providers shall be made on a statewide basis.  If credentials are approved, core privileges shall be granted on a statewide basis.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Additional privileges (not included in the core privilege or procedure list) shall be evaluated by the physician manager at the institution where such additional privileges are requested once credentials have been approved and core privileges have been granted.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Reappointment shall occur every three years.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p><strong>Procedure<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p><strong>Initial Appointment<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p>During initial appointment credentialing and privileging, the type of privileges that may be granted will depend on employment status.\u00a0 Initial privileges may be provisional, active or contract, depending upon whether the applicant is required to serve a civil service probationary period or is providing services pursuant to a contract.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>The applicant shall submit a completed CCHCS credential and privilege application package as outlined in the Licensed Medical Provider Credentialing and Privileging Documentation Requirements (Appendix 1) within 30 calendar days of receipt of the application. In addition, the applicant shall:<\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Attest that all information submitted for the credentialing and privileging process is accurate.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Agree to immediately report any change in the status of the information in the application or maintained in the credentials file.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Agree to abide by the CDCR Code of Conduct, CDCR Department Operations Manual, Section 33030.3.1, and the Licensed Medical Provider Code of Professional Conduct.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Agree to renew credentials and active privileges at least every three years.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>The CPSU shall review the application and supporting documentation, which shall include the documents listed in the Primary Source Verification Documents (Appendix 2), to determine whether the applicant meets credentialing and privileging standards as listed in the Minimum Professional Requirements for Credentialing and Privileging Approval (Appendix 3).<\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>If the application is incomplete, the CPSU shall actively work with the applicant and physician manager or HCA to gather missing information until the necessary information is obtained.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>If unable to gather information within 30 days of receipt of the credential request, the CPSU shall inform the HCA and the medical executive or physician manager who will make a determination on whether to close the request or continue with the credentialing and privileging process.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>When the application is determined to be complete, the CPSU shall forward the credentialing and privileging application and supporting documentation to the MR for review and a determination within seven calendar days of the review being assigned.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>For institutions with a licensed unit, the Chief Medical Executive (CME) shall make a privilege recommendation to the LGB for determination.\u00a0 The CME shall report the LGB\u2019s privilege determination to the CPSU.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Upon receipt of the credentialing and privileging determination, the CPSU shall do the following:<\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Civil service applicants subject to a probation period: If credentials were approved, and provisional privileges granted, the CPSU shall inform the HCA, physician manager, medical executive, and applicant of the determination.\u00a0 The length of time for provisional privileges shall be equivalent to the probationary period not to exceed 365 calendar days.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Civil service applicants not subject to a probationary period: If credentials were approved, and active privileges granted, the CPSU shall inform the HCA, physician manager, medical executive, and applicant of the decision.\u00a0 The length of time for active privileges shall not exceed three years.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Contract Applicants: If credentials are approved and contract privileges granted, the CPSU shall inform the Contracting Authority of the decision.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>For primary care advanced practice providers (APP), the CPSU shall request that the physician manager or medical executive complete and submit a signed APP Practice Agreement within five calendar days from the applicant\u2019s start date.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>If credentials are not approved, the CPSU shall notify the HCA, medical executive or DD, Medical Services or designee, and the Contracting Authority (for licensed contract providers) of the decision.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Additional Privileges<\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>A licensed medical provider may request additional privileges based on their training, experience, and the institution\u2019s needs. The licensed medical provider shall \u201cself-report\u201d competency which means they are attesting that they are proficient in the procedure and have successfully completed at least three cases within the past 24 months without complications.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>If the licensed medical provider has requested additional privileges, the CPSU shall forward the application for additional privileges and supporting documentation to the physician manager for review and determination. For CMEs who have requested additional privileges, upon credential approval, the CPSU shall forward the privileging application and supporting documentation to the Regional Deputy Medical Executive (RDME)\u00a0for review and determination.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>When privileges for additional procedure(s) are requested, the physician manager or peers competent in the requested procedure(s) shall proctor a minimum of three cases.  If the licensed medical provider requesting privileges has demonstrated competency in performing the procedure(s), this shall be noted in the privileging record and no further evaluation is needed.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>If additional oversight is needed in the performance of a procedure, the physician manager shall make the determination regarding how many more cases need to be proctored.  If the physician manager or peers at the institution are unable to provide proctoring, the institution may reach out to the RDME for assistance.  If proctoring is unavailable, the request for additional privileges shall not be granted.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p><strong>Provisional to Active Privileges<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>No less than 60 calendar days prior to expiration of provisional privileges, the CPSU shall:<\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Inform the medical executive that the licensed medical provider\u2019s provisional privileges will be expiring, the date of expiration, and the PEM due date.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>If applicable, the CPSU shall also identify any referral criteria items which are listed in Referral Criteria (Appendix 4) and:<\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Inform the physician manager of any referral criteria items.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Request that the physician manager provide additional information regarding any referral criteria items.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Once all necessary materials are gathered and no less than 30 calendar days prior to expiration of provisional privileges, the medical executive shall facilitate a PEM to review the Initial Focused Professional Practice Evaluation (IFPPEs), available peer review documentation, and referral criteria items to make a determination regarding active privileges for the licensed medical provider. The following individuals may participate in the PEM:<\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>DD, Medical Services or designee<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Assistant Deputy Medical Executive (optional)<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Deputy Medical Executive<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>MR<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Both the CME and Chief Physician and Surgeon<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Institution Hiring Authority<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Health Care Employee Relations Officer (HCERO) (if there are significant concerns regarding the licensed medical provider\u2019s performance which may warrant progressive discipline or rejection during probation)<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Once the PEM has been completed, the physician manager or medical executive shall inform CPSU of the outcome and provide a signed Attestation of Clinical Competence (ACC).\u00a0 If the physician manager or medical executive is unable to attest to the medical provider\u2019s clinical competency, an explanation of the reasons they are unable to do so shall be provided to the CPSU.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>If active privileges are granted, the CPSU shall notify the licensed medical provider.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>For licensed medical providers subject to a probationary period: If, after the PEM, the determination is that active privileges shall not be granted, the CPSU shall inform the MPRC of their recommendation, and the HCA shall work with the HCERO to prepare a Rejection During Probation (RDP). A copy of the RDP shall be provided to the MPRC.\u00a0 The MPRC shall determine whether or not the RDP was for medical disciplinary cause or reason and thus needs to be reported to the licensed medical provider\u2019s licensing board or the National Practitioner Data Bank.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p><strong>Reappointment<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>No less than 60 calendar days prior to expiration of active credentials or privileges, the CPSU shall:<\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Inform the HCA, physician manager, medical executive, and licensed medical provider of the pending credentials or privileges expiration date.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Identify and gather available peer review documentation and professional practice evaluations from the MPRC.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Identify any referral criteria items which are listed in the Referral Criteria (Appendix 4).<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Request that the physician manager or medical executive submit an ACC based on the clinical performance over the preceding three years for licensed medical providers.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>For primary care APPs, request that the physician manager or medical executive review and submit an APP Practice Agreement.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Inform and request from the physician manager any referral criteria items.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>The licensed medical provider shall submit the reappointment application no less than 30 calendar days prior to expiration of active credentials or privileges.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>When all required elements of the application have been received, the CPSU shall forward the credentialing and privileging application and supporting documentation to the MR for review and determination within seven calendar days of the review being assigned.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Upon approval of credentials and granting of statewide core privileges, the CPSU shall notify the HCA, physician manager, medical executive, and the licensed medical provider of the decision.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>If the licensed medical provider has requested additional privileges, upon approval of credentials and granting of statewide core privileges, the CPSU shall forward any application for additional privileges and supporting documentation to the physician manager. For CMEs who have requested additional privileges, upon credential approval, the CPSU shall forward the privileging application and supporting documentation to the RDME for review and determination.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>If a licensed medical provider will be providing patient care services within a licensed unit, the CPSU shall forward the approved credentialing and privileging application and supporting documentation to the HCA and their designee.\u00a0 Upon completion of the review and determination, the HCA, or designee, shall forward the LGB determination to CPSU.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>If reappointment is not approved, the CPSU shall notify the HCA of the decision and shall concurrently refer the file to the MPRC to determine whether any reports are required by law to be filed with the licensed medical provider\u2019s licensing board, the National Practitioner Data Bank, or both, and whether a referral to the HCA is necessary for further disciplinary action as a result of privileges not being granted.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p><strong>Changes to Privileging Status<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p>Privileging status changes may be initiated by the MPRC, HCEC, HCA, physician manager, medical executive, DD, Medical Services or designee, or licensed medical provider. Changes to privileging status include, but are not limited to, expiration, resignation, rejection, denial, termination, revocation, suspension, restriction, withdrawal, or abandonment of a request for credentials or privileges.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p><strong>Expiration of Privileges<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Licensed medical providers shall not be allowed to continue providing patient care if the licensed medical provider\u2019s privileges expire.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>If a civil service licensed medical provider\u2019s privileges have expired for any reason (including the licensed medical provider\u2019s failure or refusal to complete the reappointment process), the CPSU shall notify the HCA, physician manager, medical executive, or DD, Medical Services or designee of the expiration of privileges.\u00a0 The HCA shall ensure that the licensed medical provider is removed from providing patient care and shall initiate any further action which may be warranted, including progressive discipline.\u00a0 The CPSU shall concurrently refer the file to the MPRC which shall take further action pursuant to Section (d)(7).<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Contracted licensed medical providers shall be subject to termination of contract services upon the expiration of privileges.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p><strong>Automatic Termination of Privileges<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Privileges shall automatically be terminated under the following circumstances:<\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Upon permanent separation from civil service employment.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Upon the passage of 180 consecutive calendar days without providing contract services as a licensed medical provider, for any reason.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Upon termination or expiration of the contract pursuant to which the licensed medical provider is providing services<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>A licensed medical provider whose privileges were automatically terminated shall be required to reapply for credentials and privileges prior to resuming clinical care.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p><strong>Voluntary Termination of Privileges<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>A licensed medical provider who currently possesses any type or set of privileges and no longer wishes to exercise such privileges may voluntarily terminate their privileges by providing written notice to their HCA or physician manager, or medical executive, which shall include the effective date of the termination. The HCA, physician manager, or medical executive shall forward the notice of voluntary termination of privileges to the CPSU within five calendar days of the licensed medical provider\u2019s written notice.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Voluntary changes to any privileging status initiated by a licensed medical provider shall not automatically be deemed to be an unfavorable action for medical disciplinary cause or reason, triggering any form of peer review.\u00a0 However, the MPRC and HCEC retain the discretion to review all voluntary changes to a licensed medical provider\u2019s privileging status and to make an independent determination as to whether the change in privileging status warrants further reporting or action as required by law.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p><strong>Leaves of Absence<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p>In the event that a licensed medical provider\u2019s active statewide privileges expire during a leave of absence, temporary privileges may be granted without the need for a new application, not to exceed 60 calendar days from the date the licensed medical provider returns to work.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>The CPSU shall forward the most recent privileging application and supporting documentation to the MR to determine if temporary privileges should be granted.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>The licensed medical provider shall submit a current reappointment application within ten calendar days of returning to work.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p><strong>Disaster Privileges<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p>Disaster privileges may be granted to administer care, treatment, and services to patients when a disaster has been declared by the individual or agency with authority to declare a disaster or state of emergency (such as the Governor). The institution\u2019s local emergency operations plan must be activated to authorize disaster privileges. At a minimum, the process for granting disaster privileges shall include:<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>A completed Disaster Privileging Form.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>A valid, government-issued photo ID (i.e., driver\u2019s license or passport) and at least one the following:<\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Current picture identification card from a health care organization that clearly identifies professional designation.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Current license, certification, or registration to practice.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Identification indicating that the practitioner is a member of a Disaster Medical Assistance Team, the Medical Reserve Corps, the Emergency System for Advance Registration of Volunteer Health Professional, or other recognized federal or state response organization or group.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Identification indicating that the practitioner has been granted authority by a government entity to provide patient care, treatment, or services in a disaster circumstance.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Confirmation by a licensed medical provider currently privileged by the hospital or by a staff member with personal knowledge of the practitioner\u2019s ability to act as a licensed independent practitioner during a disaster.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>The CPSU shall confirm and verify the information above and Disaster Privileges shall be reviewed and granted by the MR. The physician manager or medical executive shall document their review of the licensed medical provider\u2019s clinical performance within 72 hours of granting disaster privileges to determine whether the privileges shall be continued.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p><strong>Emergency Privileges<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>For the purpose of this section, an &#8220;emergency&#8221; is defined as an unexpected or sudden event that significantly disrupts the ability to provide care or that results in a sudden, significant change or increase in the demand for the services, or a condition in which serious or permanent harm would result to a patient or in which the life of the patient is in immediate danger and any delay in administering treatment would add to that danger.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>In the case of an emergency, any licensed medical provider, to the degree permitted by their license and regardless of service or staff status or lack of it, shall be permitted and assisted to do everything possible to save the life of a patient, using every facility of the institution necessary, including the calling for any consultation necessary or desirable.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>When an emergency situation no longer exists, such licensed medical provider shall request the privileges to continue to treat the patient. In the event such privileges are denied, or they do not desire to request privileges, the patient shall be assigned to health care staff as appropriate.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p><strong>File Closure<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p>The CPSU shall close the credentialing and privileging file when any of the following conditions are met:<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>The licensed medical provider withdraws the credentialing or privileging application.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>The HCA, physician manager, medical executive, or MR withdraws the credentialing or privileging request.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>The CPSU is notified of a licensed medical provider\u2019s resignation, retirement, or death.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>The MR determines that an application will no longer be pursued.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p><strong>Privileging Actions<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>One of the following actions may occur upon request for approval of credentials and granting of privileges:<\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Credentials approval: The MR determines the licensed medical provider meets the standards for credentialing and core privileging.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Credential alert: If the MPRC determines that certain facts should be considered as part of the current or any subsequent request to approve credentials or grant privileges to the licensed medical provider, then a credential alert shall be placed in the credentials file and the MPRC, HCA, physician manager, medical executive, DD, Medical Services or designee, and MR shall consider the facts before acting on any subsequent application for credentials or privileges.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Credential bar: The MPRC shall place a credential bar in the credentials file if the MPRC determines that the licensed medical provider\u2019s unsatisfactory service has resulted in any one or more of the following:<\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Suspension or revocation of the licensed medical provider\u2019s privileges by the HCEC.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Separation for cause from civil service employment with the CCHCS.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Termination for cause of the licensed medical provider\u2019s services as a contract licensed medical provider with the CCHCS.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Any legally enforceable agreement including, but not limited to, a settlement agreement prohibiting the licensed medical provider from practicing as an employee or contract licensed medical provider with the CCHCS.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>The placement of a credential bar by the MPRC shall be forwarded to the HCEC as a consent calendar item. After placement of a credential bar in the credentials file, any subsequent application for credentials or privileges shall be reviewed by the HCEC.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Referral to the MPRC: The MR shall refer the credentials and privilege application to the MPRC for a determination in the event that the MR determines there is a need for further review of the application by the committee due to concerns as outlined in categories I &amp; II of the Referral Criteria (Appendix 4).\u00a0 The MR is not required to refer the file to the MPRC for matters that occurred more than five years prior to the date of application submission.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Denial of Privileges: If the MPRC determines that the privileges of the licensed medical provider shall be denied, the MPRC shall prepare a recommendation and referral to the HCEC. \u00a0The MPRC shall also determine whether the denial is for a medical disciplinary cause or reason, and whether the denial shall be reported to the licensed medical provider\u2019s licensing board or the National Practitioner Data Bank, or the HCA for potential disciplinary action.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p><strong>Consideration of Requests for Credentials or Privileges<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Before making a determination on a credential and privilege request, the MR shall:<\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Consider all credentialing and peer review information including credential alerts or bars, in the credentials file.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Confirm that the HCA who requested the credentialing is informed of and has considered all facts relevant to the employment or contracting decision including facts that resulted in the placement of a credential alert or bar.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>If the credentials file contains a credential bar, the MR shall refer the request to the MPRC with a recommendation for approval or disapproval. The MR is not required to refer files containing a credential alert to the MPRC if they have previously reviewed the information on which the alert is based and are satisfied that the information will not negatively reflect on the competence of the licensed medical provider.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>The MR shall approve credentials and core privileges only if they determine that the licensed medical provider:<\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Meets all credentialing and privileging requirements as delineated in this section.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Possesses the current competence and mental and physical ability to adequately discharge patient care responsibilities in a correctional setting.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p><strong>Referring Actions for Medical Disciplinary Reasons<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>The MR is not authorized to deny any application for credentials or privileges based on a medical disciplinary cause or reason within the meaning of the California Business and Professions Code, Section 805, et seq.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Where the MR recommends denial of the credentials and privilege request based on a medical disciplinary cause or reason, the MR shall refer the case to the MPRC which shall take further action pursuant to Section (d)(6).<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p><strong>Civil Service Licensed Medical Provider Transfers and Promotions<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Regardless of whether statewide privileges have expired, upon appointment to a new classification, licensed medical providers shall submit a new credentialing and privileging application pursuant to Section (f)(1) prior to starting the new position.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>If a licensed medical provider laterally transfers to a different institution or facility and stays in the same job classification, full reappointment is not required prior to the expiration of the licensed medical provider\u2019s current credentials and statewide privileges, but the licensed medical provider may apply for additional privileges at the new facility or institution.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p><strong>Appendices<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Appendix 1: Licensed Medical Provider Credentialing and Privileging Documentation Requirements<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Appendix 2: Primary Source Verification Documents<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Appendix 3: Minimum Professional Requirements for Credentialing and Privileging Approval<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Appendix 4: Referral Criteria<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p><strong>References<\/strong><\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p><em>Plata<\/em> Physician Professional Clinical Practice Review, Hearing and Privileging Procedures, Pursuant to Order Approving, With Modifications, Proposed Policies Regarding Physician Clinical Competency, July 9, 2008; <em>Plata v. Newsom, et al<\/em>., Federal Court Case No. C01-1351 published September 4, 2008, Court ordered procedures<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>California Business and Professions Code, Division 2, Chapter 5, Article 12, Sections 2234 and 2261<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>California Evidence Code, Division 9, Chapter 3, Section 1157<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>California Penal Code, Part 3, Title 7, Chapter 2, Section 5068.5<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>California Code of Regulations, Title 22, Division 5, Chapter 12. (22 CCR 79501 et seq.)<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>California Department of Corrections and Rehabilitation, Department Operations Manual, Chapter 3, Article 22, Section 33030.3.1, Code of Conduct<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p><strong>Revision History<\/strong><\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p>Effective: 12\/2017<br>Revised: 06\/23\/2025<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p><strong>Appendix 1:  Licensed Medical Provider Credentialing and Privileging Documentation Requirements<\/strong><\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p>Licensed medical providers shall complete a credentialing and privileging application and show proof of:<\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Licensure information on any active or inactive licenses.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Current certification as a Human Immunodeficiency Virus (HIV) Specialist by the American Academy of HIV. (Only applicable to licensed medical providers in the Statewide HIV Management Team).<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>California registered Drug Enforcement Administration (DEA) certificate or attestation that the licensed medical provider will obtain a California registered DEA certificate within 30 calendar days of start date. DEA certificate must possess the authority to prescribe Schedule II\/IIN, III\/IIIN, IV, and V controlled substances. Contract licensed medical providers shall have a California registered DEA certificate with authority to prescribe Schedule II\/IIN, III\/IIIN, IV, and V controlled substances.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Active Controlled Substance Utilization Review and Evaluation System (CURES) registration by providing a screenshot of User Profile.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Work History (gaps greater than six months shall be accounted for). <\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Complete contact information for three professional peer references.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Attestation Questionnaire that includes:<\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Licensed medical provider attesting to reasons for inability to perform the essential functions of the position with or without accommodation.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Lack of present illegal drug use.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>History of loss of license or criminal convictions.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>History of loss or limitation of privileges or disciplinary activity.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Attestation to the correctness and completeness of the credentialing and privileging application.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Authorization to Release Information Form.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Professional Liability Insurance (Contract Only).<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Advanced Cardiovascular Life Support (ACLS) certification from an accredited American Heart Association (AHA) training site or, for licensed civil service medical providers only, an attestation that the licensed medical provider will obtain AHA ACLS certification within 30 calendar days from the date of appointment is required for all licensed primary care medical providers. Contract licensed primary care medical providers shall have current AHA ACLS certification.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Attestation of Clinical Competence (Civil Service Only).<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Code of Conduct and Professional Behavior Form.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>California Correctional Health Care Services (CCHCS) Privilege Request Form.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Advanced Practice Provider Practice Agreement or Delegation of Services Agreement.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p>The CCHCS Human Resources or Contract Branch shall verify that the licensed medical provider requesting approval of credentials and privileges is the same licensed medical provider identified in the credentialing and privileging documents.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p><strong>Revision History<\/strong><\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p>Effective: 12\/2017<br>Revised: 06\/23\/2025<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p><strong>Appendix 2:  Primary Source Verification Documents<\/strong><\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p>The Credentialing and Privileging Support Unit shall verify the following list of documents, as required according to the licensed medical provider\u2019s classification and credential review type:<\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>California Health Care License (i.e., Medical Board of California).<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>California registered Drug Enforcement Administration (DEA) certificate, or an attestation that the licensed medical provider will obtain a California registered DEA certificate within 30 calendar days from the start date. DEA certificate must possess the authority to prescribe Schedule II\/IIN, III\/IIIN, IV and V controlled substances. Contract licensed medical providers shall have a California registered DEA certificate with authority to prescribe Schedule II\/IIN, III\/IIIN, IV, and V controlled substances.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Proof of active CURES registration.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>National Practitioner Data Bank report.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Office of Inspector General exclusions.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>American Medical Association or American Osteopathic Association.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Educational Commission for Foreign Medical Graduates.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>American Academy of HIV Medicine (only applicable to licensed medical providers in the Statewide HIV Management Team).<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Curriculum Vitae (Current within 30 calendar days), including:<\/p>\n\t\t\t\t\n\t<ul class=\"cdcr-dom-group-block\">\n\t\t\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Education.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Training.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block\">\n\t\t\t\t\t<p>Work History to include clinical duties and responsibilities (last five years).<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Professional Liability Insurance (Contract Only).<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Explanations to attestation and disclosure questions.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Signature and date on Authorization to Release Information form.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Signature and date on Affirmation of Information form (Contract Only).<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Advanced Cardiovascular Life Support (ACLS) from an accredited American Heart Association (AHA) site or attestation that the licensed medical provider will obtain AHA ACLS certification within 30 calendar days from the start date. Contract licensed medical providers shall have current AHA ACLS certification.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Attestation of Clinical Competence (Civil Service Only).<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>The Hiring or Contract Authority\u2019s recommendation for requested privileges.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Current peer review recommendations and decisions.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>References and recommendations from former California Department of Corrections and Rehabilitation institutions where the licensed medical provider has previously provided services.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Verification of residency will be requested from the program director or coordinator if the completion cannot be verified via the AMA or AOIA Profile Report.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>References and recommendations will be requested from any other relevant individuals who may have firsthand knowledge of the applicant\u2019s ability to competently perform the requested privileges.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Hospital Affiliation verification will be requested from any hospital or entity where the applicant has provided clinical services in the past five years, or is currently providing services, in order to attest to the applicant\u2019s current standing.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>APP Practice Agreement or Delegation of Services Agreement.\u00a0 For specialty APPs, the supervising physician is currently credentialed with CCHCS and practicing within the same specialty as the APP.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p><strong>Revision History<\/strong><\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p>Effective: 12\/2017<br>Revised: 06\/23\/2025<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p><strong>Appendix 3: Minimum Professional Requirements for Credentialing and Privileging Approval<\/strong><br>(Requirements listed shall be reviewed annually and updated for each discipline as needed)<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p><span style=\"text-decoration: underline\"><strong>Physician and Surgeon<\/strong><\/span><\/p>\n\t\t\t\t\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><\/td><td><strong>M.D.<\/strong><\/td><td><strong>D.O.<\/strong><\/td><\/tr><tr><td><strong>License<\/strong><\/td><td>Current unrestricted license as a Physician and Surgeon issued by the Medical Board of California.<\/td><td>Current unrestricted license as an Osteopathic Physician and Surgeon issued by the California Board of Osteopathic Examiners.<\/td><\/tr><tr><td><strong>Training<\/strong><\/td><td>Completion of a three-year residency in Internal Medicine, Family Medicine, or Family Practice (IM, FM, or FP) in a program accredited by the American Council for Graduate Medical Education (ACGME) or certified by the Royal College of Physicians and Surgeons of Canada (RCPSC).<br>&nbsp;<br><strong>NOTE:<\/strong> Licensed medical providers who have not completed all three years of residency in IM, FM, or FP may satisfy this requirement by demonstrating that their certifying board approved any non-IM, FM, or FP portion of the residency.<br>&nbsp;<br><strong>OR<\/strong><br>&nbsp;<br>Completion of one year transitional or internship in an ACGME accredited program <strong>AND<\/strong> completion of a two-year residency in IM or FM in an ACGME or RCPSC accredited program.<\/td><td>Completion of a three-year residency in IM, FM, or FP in a program accredited by the ACGME, the Bureau of Osteopathic Education of the American Osteopathic Association (AOA), or certified by the RCPSC.<br>&nbsp;<br><strong>NOTE:<\/strong> Licensed medical providers who have not completed all three years of residency in IM, FM, or FP may satisfy this requirement by demonstrating that their certifying board approved any non-IM, FM, or FP portion of the residency.<br>&nbsp;<br><strong>OR<\/strong><br>&nbsp;<br>Completion of one year transitional\/internship in an ACGME accredited program or one-year traditional rotating osteopathic internship at an AOA accredited residency program <strong>AND<\/strong> completion of a two-year residency in IM, FM, or FP in an ACGME, AOA, or RCPSC accredited program.<\/td><\/tr><tr><td><strong>Certifications<\/strong><\/td><td>Current board certification in IM, FM, or FP issued by the American Board of Medical Specialties (ABMS).<br>&nbsp;<br><strong>OR (Civil Service only)<\/strong><br>&nbsp;<br>Applicants who have completed their residency program within six months prior to applying for credentials and privileges may be appointed without current board certification but will be required to become board certified in IM, FM, or FP (issued by the ABMS) before the end of their state civil service probationary period.<br>&nbsp;<br>Current employees who were board certified in IM, FM, or FP while employed with CCHCS but have had their board certification lapse may be reappointed or re-privileged without current board certification.<\/td><td>Current board certification in IM, FM, or FP issued by the ABMS or AOA.<br>&nbsp;<br><strong>OR (Civil Service only)<\/strong><br><br>Applicants who have completed their residency program within six months prior to applying for credentials and privileges may be appointed without current board certification but will be required to become board certified in IM, FM, or FP (issued by the ABMS or AOA) before the end of their state civil service probationary period.<br>&nbsp;<br>Current employees who were board certified in IM, FM, or FP while employed with CCHCS but have had their board certification lapse may be reappointed or re-privileged without current board certification.<\/td><\/tr><tr><td><strong>Certifications<\/strong><\/td><td>Advanced Cardiovascular Life Support (ACLS) certification obtained from the American Heart Association.<br>&nbsp;<br><strong>OR (Civil Service only)<\/strong><br><br>Applicants may be appointed without current ACLS certification if an attestation that the licensed medical provider will obtain an AHA ACLS certificate within 30 calendar days from the start date is received.<\/td><td>ACLS certification obtained from the American Heart Association.<br>&nbsp;<br><strong>OR (Civil Service only)<\/strong><br><br>Applicants may be appointed without current ACLS certification if an attestation that the licensed medical provider will obtain an AHA ACLS certificate within 30 calendar days from the start date is received.<\/td><\/tr><tr><td><strong>Certifications<\/strong><\/td><td>California registered Drug Enforcement Administration (DEA) certificate with authority to prescribe Schedule II\/IIN, III\/IIIN, IV, and V controlled substances.<br>&nbsp;<br><strong>OR (Civil Service only)<\/strong><br><br>Applicants may be appointed without current DEA certification if an attestation that the licensed medical provider will update or obtain a California registered DEA certificate within 30 calendar days from the start date is received.<\/td><td>California registered DEA certificate with authority to prescribe Schedule II\/IIN, III\/IIIN, IV, and V controlled substances.<br><br><strong>OR (Civil Service only)<\/strong><br><br>Applicants may be appointed without current DEA certification if an attestation that the licensed medical provider will update or obtain a California registered DEA certificate within 30 calendar days from the start date is received.<\/td><\/tr><tr><td><\/td><td>Proof of active Controlled Substance Utilization Review and Evaluation System (CURES) registration.<\/td><td>Proof of active CURES registration.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p><strong>NOTE: <\/strong>A licensed medical provider may be appointed to the Civil Service Physician and Surgeon, Correctional Facility (P&amp;S, CF) classification only if they will be primarily practicing in a specialty area. Such licensed medical providers shall meet the following training and board certification requirements, in addition to the above requirements for license, ACLS, and DEA:<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Completion of residency in a specialty program accredited by the ACGME, AOA, or certified by the RCPSC.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-bullet\">\n\t\t\t\t\t<p>Current board certification issued by the AOA or ABMS.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p>Current and former civil service physicians and surgeons in the P&amp;S, CF classification who passed the Quality Improvement in Correctional Medicine Physician Assessment (QICM) pursuant to orders of the Court in <em>Plata v. Newsom<\/em>, U.S. District Court, Northern District, Case No. C01-1351 JST, are exempt from the training and board certification requirements listed above.\u00a0However, such licensed medical providers shall still maintain a current unrestricted license to practice medicine, ACLS certification, and DEA certificate.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p><strong>Statewide HIV Management Team<\/strong>: Licensed medical providers on the Statewide HIV Management Team shall have current certification as an HIV Specialist by the American Academy of HIV.<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p><strong><span style=\"text-decoration: underline\">Chief Physician and Surgeon<\/span><\/strong><\/p>\n\t\t\t\t\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><\/td><td><strong>M.D.<\/strong><\/td><td><strong>D.O.<\/strong><\/td><\/tr><tr><td><strong>License<\/strong><\/td><td>Current unrestricted license as a Physician and Surgeon issued by the Medical Board of California.<\/td><td>Current unrestricted license as an Osteopathic Physician and Surgeon issued by the California Board of Osteopathic Examiners.<\/td><\/tr><tr><td><strong>Training<\/strong><\/td><td>Completion of a three-year residency in Internal Medicine, Family Medicine, or Family Practice (IM, FM, or FP) in a program accredited by the American Council for Graduate Medical Education (ACGME) or certified by the Royal College of Physicians and Surgeons of Canada (RCPSC).<br>&nbsp;<br><strong>OR<\/strong><br>&nbsp;<br>Completion of one year transitional\/internship in an ACGME accredited program AND completion of a two-year residency in IM, FM, or FP in an ACGME or RCPSC accredited program.<\/td><td>Completion of a three-year residency in IM, FM, or FP in a program accredited by the ACGME, the AOA, or certified by the RCPSC.<br>&nbsp;<br><strong>OR<\/strong><br>&nbsp;<br>Completion of one year transitional\/internship in an ACGME accredited program or one-year traditional rotating osteopathic internship at an AOA accredited residency program AND completion of a two-year residency in IM, FM, or FP in an ACGME, AOA, or RCPSC accredited program.<\/td><\/tr><tr><td><strong>Certifications<\/strong><\/td><td>Current board certification in IM, FM, or FP issued by the American Board of Medical Specialties (ABMS).<br>&nbsp;<br><strong>OR (Civil Service only)<\/strong><br>&nbsp;<br>Current employees who were board certified in IM, FM, or FP while employed with CCHCS but have had their board certification lapse may be reappointed or re-privileged without current board certification.<\/td><td>Current board certification in IM, FM, or FP issued by the AMBS or AOA.<br>&nbsp;<br><strong>OR (Civil Service only)<\/strong><br>&nbsp;<br>Current employees who were board certified in IM, FM, or FP while employed with CCHCS but have had their board certification lapse may be reappointed or re-privileged without current board certification.<\/td><\/tr><tr><td><strong>Certifications<\/strong><\/td><td>Advanced Cardiovascular Life Support (ACLS) certification obtained from the American Heart Association.<br>&nbsp;<br><strong>OR (Civil Service only)<\/strong><br>&nbsp;<br>Applicants may be appointed without current ACLS certification if an attestation that the licensed medical provider will obtain an AHA ACLS certificate within 30 calendar days from the start date is received.<\/td><td>ACLS certification obtained from the American Heart Association.<br>&nbsp;<br><strong>OR (Civil Service only)<\/strong><br>&nbsp;<br>Applicants may be appointed without current ACLS certification if an attestation that the licensed medical provider will obtain an AHA ACLS certificate within 30 calendar days from the start date is received.<\/td><\/tr><tr><td><strong>Certifications<\/strong><\/td><td>California registered Drug Enforcement Administration (DEA) certificate with authority to prescribe Schedule II\/IIN, III\/IIIN, IV, and V controlled substances.<br>&nbsp;<br><strong>OR (Civil Service only)<\/strong><br>&nbsp;<br>Applicants may be appointed without current DEA certification if an attestation that the licensed medical provider will update or obtain a California registered DEA certificate within 30 calendar days from the start date is received.<\/td><td>California registered DEA certificate with authority to prescribe Schedule II\/IIN, III\/IIIN, IV, and V controlled substances.<br>&nbsp;<br><strong>OR (Civil Service only)<\/strong><br>&nbsp;<br>Applicants may be appointed without current DEA certification if an attestation that the licensed medical provider will update or obtain a California registered DEA certificate within 30 calendar days from the start date is received.<\/td><\/tr><tr><td><\/td><td>Proof of active CURES registration.<\/td><td>Proof of active CURES registration.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p><strong><span style=\"text-decoration: underline\">Receiver&#8217;s Medical Executive<\/span><\/strong><\/p>\n\t\t\t\t\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><\/td><td><strong>M.D.<\/strong><\/td><td><strong>D.O.<\/strong><\/td><\/tr><tr><td><strong>License<\/strong><\/td><td>Current unrestricted license as a Physician and Surgeon issued by the Medical Board of California.<\/td><td>Current unrestricted license as an Osteopathic Physician and Surgeon issued by the California Board of Osteopathic Examiners.<\/td><\/tr><tr><td><strong>Certifications<\/strong><\/td><td>Current board certification issued by the ABMS.<\/td><td>Current board certification issued by the ABMS or AOA.<\/td><\/tr><tr><td><strong>Certifications<\/strong><\/td><td>ACLS certification obtained from the American Heart Association.<br>&nbsp;<br><strong>OR (Civil Service only)<\/strong><br><br>Applicants may be appointed without current ACLS certification if an attestation that the licensed medical provider will obtain an AHA ACLS certificate within 30 calendar days from the start date is received.<\/td><td>ACLS certification obtained from the American Heart Association.<br>&nbsp;<br><strong>OR (Civil Service only)<\/strong><br><br>Applicants may be appointed without current ACLS certification if an attestation that the licensed medical provider will obtain an AHA ACLS certificate within 30 calendar days from the start date is received.<\/td><\/tr><tr><td><strong>Certifications<\/strong><\/td><td>California registered DEA certificate with authority to prescribe Schedule II\/IIN, III\/IIIN, IV, and V controlled substances.<br>&nbsp;<br><strong>OR (Civil Service only)<\/strong><br><br>Applicants may be appointed without current DEA certification if an attestation that the licensed medical provider will update or obtain a California registered DEA certificate within 30 calendar days from the start date is received.<\/td><td>California registered DEA certificate with authority to prescribe Schedule II\/IIN, III\/IIIN, IV, and V controlled substances.<br>&nbsp;<br><strong>OR (Civil Service only)<\/strong><br><br>Applicants may be appointed without current DEA certification if an attestation that the licensed medical provider will update or obtain a California registered DEA certificate within 30 calendar days from the start date is received.<\/td><\/tr><tr><td><\/td><td>Proof of active CURES registration.<\/td><td>Proof of active CURES registration.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p><strong><span style=\"text-decoration: underline\">Advanced Practice Registered Nurse \u2013 Nurse Practitioner<\/span><\/strong><\/p>\n\t\t\t\t\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>License<\/strong><\/td><td>Current unrestricted license as a Registered Nurse issued by the California Board of Registered Nursing.<\/td><\/tr><tr><td><strong>License<\/strong><\/td><td>Current unrestricted certificate as a Nurse Practitioner issued by the California Board of Registered Nursing.<\/td><\/tr><tr><td><strong>License<\/strong><\/td><td>Current Nurse Practitioner Furnishing Number issued by the California Board of Registered Nursing.<\/td><\/tr><tr><td><strong>Certifications<\/strong><\/td><td>ACLS certification obtained from the American Heart Association.<br>&nbsp;<br><strong>OR (Civil Service only)<\/strong><br><br>Applicants may be appointed without current ACLS certification if an attestation that the licensed medical provider will obtain an AHA ACLS certificate within 30 calendar days from the start date is received.<\/td><\/tr><tr><td><strong>Certifications<\/strong><\/td><td>California registered DEA certificate with authority to prescribe Schedule II\/IIN, III\/IIIN, IV, and V controlled substances.<br>&nbsp;<br><strong>OR (Civil Service only)<\/strong><br><br>Applicants may be appointed without current DEA certification if an attestation that the licensed medical provider will update or obtain a California registered DEA certificate within 30 calendar days from the start date is received.<\/td><\/tr><tr><td><\/td><td>Proof of active CURES registration.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p><strong><span style=\"text-decoration: underline\">Physician Assistant<\/span><\/strong><\/p>\n\t\t\t\t\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>License<\/strong><\/td><td>Current unrestricted license as a Physician Assistant issued by the California Physician Assistant Board.<\/td><\/tr><tr><td><strong>Certifications<\/strong><\/td><td>ACLS certification obtained from the American Heart Association.<br>&nbsp;<br><strong>OR (Civil Service applicants only)<\/strong><br>&nbsp;<br>Applicants may be appointed without current ACLS certification if an attestation that the licensed medical provider will obtain an AHA ACLS certificate within 30 calendar days from the start date is received.&nbsp;&nbsp;&nbsp;<\/td><\/tr><tr><td><strong>Certifications<\/strong><\/td><td>California registered DEA certificate with authority to prescribe Schedule II\/IIN, III\/IIIN, IV, and V controlled substances.<br>&nbsp;<br><strong>OR (Civil Service Only)<\/strong><br><br>Applicants may be appointed without current DEA certification if an attestation that the licensed medical provider will update or obtain a California registered DEA certificate within 30 calendar days from the start date is received.<\/td><\/tr><tr><td><\/td><td>Proof of active CURES registration.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p><span style=\"text-decoration: underline\"><strong>Specialty Licensed Medical Provider<\/strong><\/span><\/p>\n\t\t\t\t\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>License<\/strong><\/td><td>Physician (MD):&nbsp; Current unrestricted license as a Physician and Surgeon issued by the Medical Board of California.<br>&nbsp;<br>Osteopathic Physician (DO):&nbsp; Current unrestricted license as an Osteopathic Physician and Surgeon issued by the California Board of Osteopathic Examiners.<br><br>Podiatrist:&nbsp; Current unrestricted license as a Podiatrist issued by the Podiatric Medical Board of California.<br>&nbsp;<br>Nurse Anesthetist: Current unrestricted License as a Registered Nurse AND advance practice certification as a Nurse Anesthetist issued by the California Board of Registered Nursing.<br>&nbsp;<br>Nurse Practitioner Specialist:&nbsp; Current unrestricted License as a Registered Nurse, certification as a Nurse Practitioner, and a current Nurse Practitioner Furnishing Number issued by the California Board of Registered Nursing.<br>&nbsp;<br>Physician Assistant Specialist: Current unrestricted license as a Physician Assistant issue by the California Physician Assistant Board.<br>&nbsp;<br>Optometrists: Current unrestricted licenses as an Optometrist issued by the California State Board of Optometry<\/td><\/tr><tr><td><strong>Training<\/strong><\/td><td>Physician (MD): Successful completion of a residency or fellowship program in the relevant specialty that is accredited by the American Council for Graduate Medical Education or certified by the Royal College of Physicians and Surgeons of Canada.<br><br>Osteopathic Physician (DO): Successful completion of a residency or fellowship program in the relevant specialty that is accredited by the Bureau of Osteopathic Education of the American Osteopathic Association or the American Council for Graduate Medical Education or certified by the Royal College of Physician and Surgeons of Canada.<br>&nbsp;<br>Podiatrists:&nbsp; Successful completion of a Council on Podiatric Medical Education (CPME) approved.<br>&nbsp;<br>Optometrists:&nbsp; Twelve (12) continuous months of experience within in the last three (3) years performing optometry services.&nbsp; Note: Internship does not count toward the required experience.<\/td><\/tr><tr><td><strong>Certifications<\/strong><\/td><td>Physician (MD): Current board certification in the relevant specialty or subspecialty issued by the American Board of Medical Specialties (ABMS).<br>&nbsp;<br>Osteopathic Physician (DO):&nbsp; Current board certification in the relevant specialty or subspecialty issued by the ABMS or American Osteopathic Association.<br>&nbsp;<br>Podiatrist:&nbsp; Current board certification in Podiatry issued by the American Board of Foot and Ankle Surgery or the American Board of Podiatric Medicine.<br>&nbsp;<br>Nurse Anesthetists:&nbsp; Current certification issued by the American Nurses Credentialing Center (ANCC) or the American Academy of Nurse Practitioners (AANP)<br>&nbsp;<br>Nurse Practitioner Specialist: Current certification issued by the American Nurses Credentialing Center (ANCC) or the American Academy of Nurse Practitioners (AANP)<br>&nbsp;<br>Physician Assistant Specialist: Current certification issued by the National Commission on the Certification of Physician Assistants (NCCPA). A Certificate of Added Qualification (CAQ) issued by the NCCPA is required if offered in the provider\u2019s specialty.<br><br>California registered DEA certificate with authority to prescribe Schedule 11\/IIN, III\/IIIN, IV, and V controlled substances.<br><br>Proof of active CURES registration.<br>&nbsp;<br><strong>NOTE:<\/strong> Nurse Anesthetists, Sleep Medicine Specialists, Radiologists, ECG Cardiologists, eConsult providers, and Optometrists are not required to possess a CA registered DEA or provide proof of active CURES registration.<\/td><\/tr><tr><td><strong>Additional <br>Requirement<\/strong><\/td><td>Specialty Advance Practice Providers<br><br>The supervising physician on the APP Practice Agreement or Delegation of Services Agreement must be currently credentialed by CCHCS and practicing within the same specialty as the specialty APP.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p><strong>Revision History<\/strong><\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p>Effective: 12\/2017<br>Revised: 06\/23\/2025<\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p><strong>Appendix 4:  Referral Criteria<\/strong><\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p>Additional evaluation by the Hiring or Contracting Authority and the Medical Peer Review Committee (MPRC) is required based on the presence of one or more of the issues identified below. However, if any of the following referral criteria items have previously been reviewed and credentials were approved, they do not need to be reviewed as part of any subsequent credentialing or privileging evaluations if it is the exact same referral criteria item.  In addition, if the MR determines that the identified issue is minor in nature or occurred over five years ago with no subsequent issues or concerns, additional evaluation by the MPRC is not required but may be requested at the MR\u2019s discretion.<\/p>\n\t\t\t\t\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>License Status<\/strong><\/td><\/tr><tr><td>State health care license presents with a Board Accusation.<\/td><\/tr><tr><td>State health care license presents with a Board Action \u2013 Suspension, Probation.<\/td><\/tr><tr><td>Business and Professions Code section 805 report (exclude reports for non-change of address).<\/td><\/tr><tr><td><strong>National Practitioner Data Bank Report<\/strong><\/td><\/tr><tr><td>Any claims history.<\/td><\/tr><tr><td><strong>Performance<\/strong><\/td><\/tr><tr><td>The current supervisor, or former supervisor does not endorse the applicant for core privileges.<\/td><\/tr><tr><td>Prior peer review proceedings which were initiated, but not completed, or action items resulting from the prior peer review finding remain incomplete.<\/td><\/tr><tr><td><strong>Criminal Background<\/strong><\/td><\/tr><tr><td>Practitioner attests to drug use or criminal activity or background check \u2013 misdemeanor or felony.<\/td><\/tr><tr><td><strong>Certifications<\/strong><\/td><\/tr><tr><td>Change in Drug Enforcement Administration Certification status.<\/td><\/tr><tr><td>Change in Advanced Cardiovascular Life Support Certification status.<\/td><\/tr><tr><td><strong>Miscellaneous<\/strong><\/td><\/tr><tr><td>Federal Office of Inspector General exclusions.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p><strong>Revision History<\/strong><\/p>\n\t\t\t\t\t<\/li>\n\t\n\n\t<li class=\"cdcr-dom-item-block is-style-no-marker\">\n\t\t\t\t\t<p>Effective: 12\/2017<br>Revised: 06\/23\/2025<\/p>\n\t\t\t\t\t<\/li>\n\t\n\t<\/ul>\n\t","protected":false},"parent":253,"template":"","class_list":["post-1275","dom","type-dom","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>1.4.1.2 Licensed Medical Provider Credentialing and Privileging - Health Care Department Operations Manual (HCDOM)<\/title>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"1.4.1.2 Licensed Medical Provider Credentialing and Privileging - Health Care Department Operations Manual (HCDOM)\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.cdcr.ca.gov\/hcdom\/dom\/chapter-1-health-care-governance-and-administration\/article-4-1-professional-workforce-credentialing-and-privileging\/1-4-1-2-licensed-medical-provider-credentialing-and-privileging\/\" \/>\n<meta property=\"og:site_name\" content=\"Health Care Department Operations Manual (HCDOM)\" \/>\n<meta property=\"article:modified_time\" content=\"2025-09-22T18:37:57+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"12 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.cdcr.ca.gov\\\/hcdom\\\/dom\\\/chapter-1-health-care-governance-and-administration\\\/article-4-1-professional-workforce-credentialing-and-privileging\\\/1-4-1-2-licensed-medical-provider-credentialing-and-privileging\\\/\",\"url\":\"https:\\\/\\\/www.cdcr.ca.gov\\\/hcdom\\\/dom\\\/chapter-1-health-care-governance-and-administration\\\/article-4-1-professional-workforce-credentialing-and-privileging\\\/1-4-1-2-licensed-medical-provider-credentialing-and-privileging\\\/\",\"name\":\"1.4.1.2 Licensed Medical Provider Credentialing and Privileging - Health Care Department Operations Manual (HCDOM)\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.cdcr.ca.gov\\\/hcdom\\\/#website\"},\"datePublished\":\"2023-12-05T21:51:00+00:00\",\"dateModified\":\"2025-09-22T18:37:57+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/www.cdcr.ca.gov\\\/hcdom\\\/dom\\\/chapter-1-health-care-governance-and-administration\\\/article-4-1-professional-workforce-credentialing-and-privileging\\\/1-4-1-2-licensed-medical-provider-credentialing-and-privileging\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/www.cdcr.ca.gov\\\/hcdom\\\/dom\\\/chapter-1-health-care-governance-and-administration\\\/article-4-1-professional-workforce-credentialing-and-privileging\\\/1-4-1-2-licensed-medical-provider-credentialing-and-privileging\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/www.cdcr.ca.gov\\\/hcdom\\\/dom\\\/chapter-1-health-care-governance-and-administration\\\/article-4-1-professional-workforce-credentialing-and-privileging\\\/1-4-1-2-licensed-medical-provider-credentialing-and-privileging\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/www.cdcr.ca.gov\\\/hcdom\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"HCDOM\",\"item\":\"https:\\\/\\\/www.cdcr.ca.gov\\\/hcdom\\\/dom\\\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Chapter 1 &#8211; Health Care Governance and Administration\",\"item\":\"https:\\\/\\\/www.cdcr.ca.gov\\\/hcdom\\\/dom\\\/chapter-1-health-care-governance-and-administration\\\/\"},{\"@type\":\"ListItem\",\"position\":4,\"name\":\"Article 4.1 \u2013 Professional Workforce: Credentialing and Privileging\",\"item\":\"https:\\\/\\\/www.cdcr.ca.gov\\\/hcdom\\\/dom\\\/chapter-1-health-care-governance-and-administration\\\/article-4-1-professional-workforce-credentialing-and-privileging\\\/\"},{\"@type\":\"ListItem\",\"position\":5,\"name\":\"1.4.1.2 Licensed Medical Provider Credentialing and Privileging\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/www.cdcr.ca.gov\\\/hcdom\\\/#website\",\"url\":\"https:\\\/\\\/www.cdcr.ca.gov\\\/hcdom\\\/\",\"name\":\"Health Care Department Operations Manual\",\"description\":\"CCHCS\",\"publisher\":{\"@id\":\"https:\\\/\\\/www.cdcr.ca.gov\\\/hcdom\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/www.cdcr.ca.gov\\\/hcdom\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/www.cdcr.ca.gov\\\/hcdom\\\/#organization\",\"name\":\"Health Care Department Operations Manual\",\"url\":\"https:\\\/\\\/www.cdcr.ca.gov\\\/hcdom\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/www.cdcr.ca.gov\\\/hcdom\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/www.cdcr.ca.gov\\\/hcdom\\\/wp-content\\\/uploads\\\/sites\\\/207\\\/2023\\\/08\\\/cropped-cdcr-cchcs-logos-512.png\",\"contentUrl\":\"https:\\\/\\\/www.cdcr.ca.gov\\\/hcdom\\\/wp-content\\\/uploads\\\/sites\\\/207\\\/2023\\\/08\\\/cropped-cdcr-cchcs-logos-512.png\",\"width\":82,\"height\":82,\"caption\":\"Health Care Department Operations Manual\"},\"image\":{\"@id\":\"https:\\\/\\\/www.cdcr.ca.gov\\\/hcdom\\\/#\\\/schema\\\/logo\\\/image\\\/\"}}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"1.4.1.2 Licensed Medical Provider Credentialing and Privileging - Health Care Department Operations Manual (HCDOM)","robots":{"index":"noindex","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"og_locale":"en_US","og_type":"article","og_title":"1.4.1.2 Licensed Medical Provider Credentialing and Privileging - Health Care Department Operations Manual (HCDOM)","og_url":"https:\/\/www.cdcr.ca.gov\/hcdom\/dom\/chapter-1-health-care-governance-and-administration\/article-4-1-professional-workforce-credentialing-and-privileging\/1-4-1-2-licensed-medical-provider-credentialing-and-privileging\/","og_site_name":"Health Care Department Operations Manual (HCDOM)","article_modified_time":"2025-09-22T18:37:57+00:00","twitter_card":"summary_large_image","twitter_misc":{"Est. reading time":"12 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/www.cdcr.ca.gov\/hcdom\/dom\/chapter-1-health-care-governance-and-administration\/article-4-1-professional-workforce-credentialing-and-privileging\/1-4-1-2-licensed-medical-provider-credentialing-and-privileging\/","url":"https:\/\/www.cdcr.ca.gov\/hcdom\/dom\/chapter-1-health-care-governance-and-administration\/article-4-1-professional-workforce-credentialing-and-privileging\/1-4-1-2-licensed-medical-provider-credentialing-and-privileging\/","name":"1.4.1.2 Licensed Medical Provider Credentialing and Privileging - Health Care Department Operations Manual (HCDOM)","isPartOf":{"@id":"https:\/\/www.cdcr.ca.gov\/hcdom\/#website"},"datePublished":"2023-12-05T21:51:00+00:00","dateModified":"2025-09-22T18:37:57+00:00","breadcrumb":{"@id":"https:\/\/www.cdcr.ca.gov\/hcdom\/dom\/chapter-1-health-care-governance-and-administration\/article-4-1-professional-workforce-credentialing-and-privileging\/1-4-1-2-licensed-medical-provider-credentialing-and-privileging\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.cdcr.ca.gov\/hcdom\/dom\/chapter-1-health-care-governance-and-administration\/article-4-1-professional-workforce-credentialing-and-privileging\/1-4-1-2-licensed-medical-provider-credentialing-and-privileging\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/www.cdcr.ca.gov\/hcdom\/dom\/chapter-1-health-care-governance-and-administration\/article-4-1-professional-workforce-credentialing-and-privileging\/1-4-1-2-licensed-medical-provider-credentialing-and-privileging\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/www.cdcr.ca.gov\/hcdom\/"},{"@type":"ListItem","position":2,"name":"HCDOM","item":"https:\/\/www.cdcr.ca.gov\/hcdom\/dom\/"},{"@type":"ListItem","position":3,"name":"Chapter 1 &#8211; Health Care Governance and Administration","item":"https:\/\/www.cdcr.ca.gov\/hcdom\/dom\/chapter-1-health-care-governance-and-administration\/"},{"@type":"ListItem","position":4,"name":"Article 4.1 \u2013 Professional Workforce: Credentialing and Privileging","item":"https:\/\/www.cdcr.ca.gov\/hcdom\/dom\/chapter-1-health-care-governance-and-administration\/article-4-1-professional-workforce-credentialing-and-privileging\/"},{"@type":"ListItem","position":5,"name":"1.4.1.2 Licensed Medical Provider Credentialing and Privileging"}]},{"@type":"WebSite","@id":"https:\/\/www.cdcr.ca.gov\/hcdom\/#website","url":"https:\/\/www.cdcr.ca.gov\/hcdom\/","name":"Health Care Department Operations Manual","description":"CCHCS","publisher":{"@id":"https:\/\/www.cdcr.ca.gov\/hcdom\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.cdcr.ca.gov\/hcdom\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/www.cdcr.ca.gov\/hcdom\/#organization","name":"Health Care Department Operations Manual","url":"https:\/\/www.cdcr.ca.gov\/hcdom\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.cdcr.ca.gov\/hcdom\/#\/schema\/logo\/image\/","url":"https:\/\/www.cdcr.ca.gov\/hcdom\/wp-content\/uploads\/sites\/207\/2023\/08\/cropped-cdcr-cchcs-logos-512.png","contentUrl":"https:\/\/www.cdcr.ca.gov\/hcdom\/wp-content\/uploads\/sites\/207\/2023\/08\/cropped-cdcr-cchcs-logos-512.png","width":82,"height":82,"caption":"Health Care Department Operations Manual"},"image":{"@id":"https:\/\/www.cdcr.ca.gov\/hcdom\/#\/schema\/logo\/image\/"}}]}},"distributor_meta":false,"distributor_terms":false,"distributor_media":false,"distributor_original_site_name":"Health Care Department Operations Manual (HCDOM)","distributor_original_site_url":"https:\/\/www.cdcr.ca.gov\/hcdom","push-errors":false,"_links":{"self":[{"href":"https:\/\/www.cdcr.ca.gov\/hcdom\/wp-json\/wp\/v2\/dom\/1275","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.cdcr.ca.gov\/hcdom\/wp-json\/wp\/v2\/dom"}],"about":[{"href":"https:\/\/www.cdcr.ca.gov\/hcdom\/wp-json\/wp\/v2\/types\/dom"}],"version-history":[{"count":20,"href":"https:\/\/www.cdcr.ca.gov\/hcdom\/wp-json\/wp\/v2\/dom\/1275\/revisions"}],"predecessor-version":[{"id":3340,"href":"https:\/\/www.cdcr.ca.gov\/hcdom\/wp-json\/wp\/v2\/dom\/1275\/revisions\/3340"}],"up":[{"embeddable":true,"href":"https:\/\/www.cdcr.ca.gov\/hcdom\/wp-json\/wp\/v2\/dom\/253"}],"wp:attachment":[{"href":"https:\/\/www.cdcr.ca.gov\/hcdom\/wp-json\/wp\/v2\/media?parent=1275"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}