QUICK NAVIGATION

• Medical Staff Services
  • Medical Staff Application
  • Delineation of Privileges Form
  • MEDITECH Training
  • Physician Careers
  • Hospital Affiliation Verification
  • Meeting Calendar
  • National Patient Safety Goals

Applying for Privileges

To apply for privileges at CalvertHealth Medical Center, please complete the following steps:

1. Download and complete the Maryland State Credentials form.
2. Download and complete the CalvertHealth Supplemental Application form.
3. Fill out the Delineation of Privileges form request. The appropriate form for your specialty will be e-mailed to you within two business days.
4. Once completed, mail all three forms to the mailing address below.

CalvertHealth
ATTN: Medical Staff Services
100 Hospital Road
Prince Frederick, MD 20678

If you have any questions, please contact us at LINDA.TIERNEY@Calverthealthmed.org or 410-535-8242

Other Required Forms

• Cover Letter
• PPD Respiratory Form
• Malpractice Claims History Reporting Form & Authorization to Release
• Contact Information Form
• Vaccination Requirements (Policy & HR Notice)
• Tuberculosis Skin Test
• Criminal Records and Background Release - Authorization and Disclosure
• Rules & Regulations
• Summary of Your Rights Under FCRA (english)
• Summary of Your Rights Under FCRA (spanish)

Special Privilege Requests

• Procedure Sedation Packet & Test
• Fluoroscopy Packet & Test