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Medical Staff Affairs
Provider Applications And Requests

Tools & Resources

Provider Applications and Requests

Each Presbyterian Medical Staff Affairs Office oversees all provider applications and requests for their Medical Staff. Please see links for specific applications and requests:

Hospital Privilege Application

Through our online application process, a provider may request and apply for privileges and/or membership at one or multiple Presbyterian Healthcare Services' hospitals and/or clinics. In addition, providers currently on staff will have the opportunity to complete and submit their application through our online application process. The Presbyterian CVO team will perform the primary source verification on behalf of the hospitals and/or clinics.

Initial Application Request

Reappointment Applications & Changing Privileges

If you need to complete your reappointment application, please contact the CVO at

If you have questions regarding reappointment or changing your privileges, please contact the appropriate Medical Staff Affairs office

Voluntary Resignation

If you do not wish to be reappointed to the Medical Staff or wish to resign, please submit the resignation letter request form linked below.

Voluntary Resignation form

Provider Affiliation Verification

Presbyterian Healthcare Services is pleased to provide an online portal for instant verification of Medical Staff affiliations can be obtained.

Verification Lookup Portal

When requesting information on a provider, you will be required to complete the fields with red asterisks, then check the acknowledgement box. Once complete, please select the search button and your provider’s name will appear. Select their name and the results will be given. If you have any questions regarding the results, please contact the appropriate Medical Staff Affairs office

The portal includes practitioner status information and is maintained by the Presbyterian Medical Staff Affairs Offices. All information contained in the database is secure and cannot be altered by outside parties, therefore meeting Joint Commission standards.

Provider Activity of Case Log Request

If you are a provider in need of a case log of your activities/procedures performed, please make your request by sending an e-mail to

Certificate of Insurance Request

If you are an employed provider and need a copy of your certificate of insurance, or require claims information, please visit us on PresNet for more information.

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