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Allied Health Staff Forms

The following documents are utilized for appointment and reappointment to the Allied Health Professional Staff of Hendrick Medical Center:

* Texas Standardized Credentialing Application - This document is located on the Texas Department of Insurance website. To ensure that you do not lose data you must save the document to your computer first and then input pertinent information.

* Initial Application Addendum - This addendum is required of all initial applicants. It contains information not included on the Texas Standardized Credentialing Application that Hendrick Medical Center is required to obtain. Some of the questions may seem redundant but they are different.

* Reappointment Addendum - This addendum must be utilized by practitioners who are already on staff and are requesting reappointment. It contains information not included on the Texas Standardized Credentialing Application that Hendrick Medical Center is required to obtain. Some of the questions may seem redundant but they are different.

TB Test Form – This document needs to be completed by the appropriate healthcare professional at Hendrick Medical Center Employee Wellness Office or by a physician on a yearly basis.

* Scope of Practice/Clinical Privilege Request Forms – You must contact the Medical Staff Office to obtain these documents.

* Orientation Checklist – You must contact the Medical Staff Office to obtain this document.

Apollo Access Agreement - This license agreement for access to Hendrick Information Network is required upon initial application.

* These documents are required for reappointment.

Please print and complete each of these documents and return them to Medical Staff Services. If you have any questions, please contact the Tammy Estes, in the Medical Staff Services at 325-670-3465.