Credentialing:

Credentialing Coordinator:

Kelli Larson

Kelli.Larson@amitahealth.org

Dorothy Conway

Dorothy.Conway@amitahealth.org

Accepts Castle Branch for document sharing.

Streamlined credentialing process. Everything should be worked out before you arrive, and you will not need to bring any additional forms on your first day. Send the forms that are listed here.

1. AMITA Health Orientation

2. Confidentiality Agreement

3. Verification of mandatory screenings (send all of these documents via CB and fill out the form)

For EPIC Access: At least 2 weeks before your rotation, send the following items to the clinical coordinator.

• Send her: Full Name (First Middle Last),

• Last 4 of SS#

• Birthday

• contact number

COVID Vaccination is required.

For those residents, fellows and students currently in rotations or beginning rotations prior to November 12, 2021, schools must promptly submit to the host program by September 19, 2021 either the exemption form or the required documentation demonstrating that the individual is fully vaccinated. For those individuals starting their rotations on November 12, 2021 or afterward, all documentation must be received prior to the start of the rotation. Failure to comply with these documentation requirements may result in discontinuation or delay of an individual’s program participation at our facilities.

For those residents, fellows, students, and faculty who have been granted an exemption will be required to submit to the program weekly negative COVID-19 test results. For those individuals who haven’t completed a two-shot series until the deadline of November 12, 2021, they too must submit weekly negative COVID-19 test results until they are “fully” vaccinated on November 26, 2021, which occurs two weeks after the 2 nd shot.

Please forward the exemption forms and all other vaccination documentation, including

test results, to Linda.ramirez@amitahealth.org.

If you have any questions on the content of this memorandum, do not hesitate to reach out to

Linda at (773) 990-7763or at linda.ramirez@@amitahealth.org.