Applications for Medical Staff – Credentialing Documents

Delta Health Medical Staff Services

Thank you for your interest in our credentialing process at Delta Health. In order to begin the credentialing process at our facility, we require you to complete and return all items listed on the New Applicant Checklist.

The Colorado legislature has mandated that all health care entities and health care plans engaged in the collection of information to be used in the process of credentialing of health care professionals use the Colorado Health Care Professionals Application (C.R.S. § 25-1-108.7). This uniform application has been designed to allow each credentialing entity to receive information needed in common, without duplication.

Please read all documents carefully to ensure accurate and full completion. As an applicant, you are responsible for producing the requested documentation to support your application for initial and ongoing eligibility for medical staff membership and privileges.

If you have any questions, please do not hesitate to contact the Medical Staff Coordinator by telephone: 970-399-2850, by fax: 970-399-2859, or by email: gconrad@deltahealthco.org. Thank you again for visiting our Medical Staff Provider page.

To become a member of the Delta Health Medical Staff, please be sure to submit the following:

• New Applicant Checklist
• Colorado Health Care Professional
• Credentials Application (Word)
• Colorado Health Care Professional Credentials Application (PDF)
• Delta Health Staff Category Form
• COPIC Release for Certificate of Insurance and/or Claim History
• Non-COPIC Release for Certificate of Insurance and/or Claim History
• Delta Health Provider Signature Page
• Delta Health Provider Medicare Medicaid Attestation
• Delta Health Provider Confidentiality Agreement

• Delta Health Medical Staff Bylaws
• Delta Health Map of the Facility
• Delta Health Orientation Packet