Physician Orientation Verification and Completion

If you have completed orientation, please fill out and submit the form below. A representative from our Medical Staff Office will contact you with further instructions.

Name*

Specialty*

Email*

Street Address

City

State

Country

Zip Code

Phone Number

Orientation Sections

By checking the boxes below, you verify that you have read and understand the content of the orientation section. You are required to complete all sections that pertain to your specialty.

Credentialing

Code of Conduct Poicy

Patient-Centered Pledge

Corporate Compliance

Quality and Patient Safety

Health Information Services

Call Coverage

Information Technology

Joint Commission Guide

Emergency Management and Safety

Time Outs

Operating Room

Services Agreement re: Participation in Meetings and Programs

Electronic Signature*

By signing below, you are verifying that you have read, understand and agree to the content of Hendrick Medical Center's online physician orientation.

Send me a copy of my responses

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