Medical Staff Application

Forms due by: March 31, 2023

Please download and complete the forms below and email them to Denise Gleason.  **You can electronically sign these forms**

Shortly after, you will receive an email from Providence Medical Staff, Aspen Knight, who will be sending you two emails - one with the link to your online application and the other with your password.  

Of note: 

The Meaningful Use Form: Disregard the questions on this form and note that you do not have to add your license, NPI, etc.  Just fill in your name and sign and attest for meaningful use reporting.  

Identity Form: This is for the pharmacy, as they use it to confirm resident signatures/initials.