For Physicians
Application Instructions
Instructions for the use of the Maryland Hospital Credentialing Application:
- The State of Maryland Hospital Credentialing Application shall be used for the purpose of initial application for all staff, both physician and allied health professionals, applying for privileges at a Maryland hospital.
- Applicants must contact BWMC when they are applying to obtain this application and any specific instructions or additional forms at 410-787-4527. BWMC has additional requirements, supplements and attestations as determined by its governing body, Medical Staff Bylaws or credentialing process, which may be included as part of this application and may be necessary for its completion.
- All entries must be legible and complete
- The application must be complete. Mark "not applicable" in those areas that are not appropriate for specific training, education or experience.
- Copies of all requested licenses, documents or explanations must be included with the application.
- Any page of the application may be copied in order to have sufficient space to provide all requested education, training, employment or liability case information.
- This application must be reviewed, updated and signed when applying to the hospital for employment, medical staff membership or privileges.
- Each application must have an original signature and be dated within 10 days of submitting the application.
- Although the Maryland law allows for this form to be used by hospitals that perform delegated credentialing for managed care organizations in lieu of the Maryland Insurance Administration Uniform Credentialing Form, please check with each managed care organization to determine if that organization will accept this form.
Please Note: This form will be periodically reviewed and updated by the Department of Health and Mental Hygiene whenever necessary to meet licensure, federal certification and accrediting body requirements.
Click here for the Maryland Hospital Credentialing Application.
