Medical Staff Application

Thank you for your interest in applying for the Pioneers Memorial Healthcare District Medical Staff.

The Medical Staff Application process is divided into six sections:

1. Medical Staff Application
2. Application Fee
3. Medical Staff Categories Grid
4. Privilege Forms
5. Moderate Sedation Module
6. Where to Mail the Packet

Important

Before you return the application packet, please review all of your materials thoroughly for accuracy, completeness, signatures and dates.  Please note that we cannot begin processing your application until the items listed below have been received, including all check boxes, blanks, and signatures completed. 

• All professional licenses in California and other states
• Board Certification  (if applicable)
• DEA certificate
• X-Ray/Fluoroscopy certificate (if applicable to your specialty: urology, cardiology,  pulmonary, gastroenterology, orthopedics, neurosurgery, surgery, radiology, and radiation oncology)
• Curriculum Vitae or Resume covering your work history for the last ten years
• Malpractice Insurance Certificate and names of any other insurance carriers during the last ten years.
• All supporting forms (Attachments 1 thru 15) of the application
• Photocopy of driver’s license, passport or other government issued picture identification
• Application Fee of $300.00 per facility

Please note: Emergency Medicine, Anesthesia, Pathology & Medical Imaging are exclusive services available only through the groups contracted. No independent applications will be accepted. If you would like information on how to contact the above groups, please feel free to call.

• FAQ for Applicants

To begin the application process, please click here.