Medical Staff Application

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 our team by emailing medicalstaffservices@calverthealthmed.org or 410.535.8242

Other Required Forms

• Cover Letter
• Authorization to Release Form
• Criminal Records and Background Release - Authorization and Disclosure
• Drug Free Workplace Policy