Credentialing Application

Application for Hospital Privileges

  1. Hospital Appointment Approval Process
  2. Items to be Completed by the Applicant (Physician, Dentist, Midwife)
  3. Items to be Completed by the Department Contact
  4. Disclaimer
  5. Preparing for your First Day

If you have any question about this process, please contact Gloria Castelo, Medical Affairs Professional Staff Planning and Credentialing Specialist at 519 685-8500 ext. 75127.

Hospital Appointment Approval Process

All applications for privileges to the London Health Sciences Centre (LHSC) and St. Joseph's Health Care London (St. Joseph's) must be reviewed by the City-Wide Credentials Committee (CWCC) and subsequent recommendation to the Joint Medical Advisory Committee (MAC), which must approve the procedural privileges and recommend your appointment(s) to the Board of Directors for London Health Sciences Centre and St. Joseph's Health Care London.

The approval process generally takes 6 weeks. All applications and supporting documents should be submitted at least 8 weeks prior to the anticipated start date. Late submission may result in a delayed start date.

Application for Hospital Privileges - Submission Schedule

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Items to be Completed by the Applicant (Physician, Dentist, Midwife)

**All documents must be converted to PDF before sending to Medical Affairs. The hospital is currently removing all Microsoft Word files with a .doc extension from all internal and external emails.

1. Application Package
2. Joint Reference Form

Clinical Academics who have already obtained three references as part of the initial interview process would have already completed this step

* This form works best when using Internet Explorer

  • Email this form directly to your chosen three referees
  • The standard reference form must be used. Personal reference letters will not be accepted.
  • Request the referee to send the completed confidential reference directly to Medical Affairs at @email
  • At least one reference must be from an immediate supervisor
3. City-Wide Health Screen Form
  • All health information is confidential. Please submit the completed form via email and supporting health documentation directly to Occupational Health at your primary affiliation:
    • Primary affiliation - St. Joseph's - email to Occupation Health / fax to 519-646-6235
    • Primary affiliation - LHSC - email to Occupational Health / fax: 519-667-6753
  • You will not be able to begin your appointment until you are completely cleared by Occupational Health
4. Current Curriculum Vitae
  • Email to Medical Affairs at @email and copy your department contact
5. Certification of Registration to Practice in Ontario
6. Current Confirmation of Professional Conduct/Letter of Standing

For Physician applicants

CPSO - Institutional Request for Certificate of Professional Conduct (CPC) Form

  • CPSO may take up to 5 business days to process

  • The applicant is responsible to email the completed form directly to @email or fax to 1-416-967-2654
  • Ensure that your credit card information is on the form and witnessed to avoid delays in processing
  • Certificate needs to be aligned to an Independent or Restricted certificate type (certificates with Postgraduate Education will not be accepted)
  • Form is to be requested to the attention of:

Medical Affairs

Professional Staff Planning and Credentialing Specialist
London Health Sciences Centre
St. Joseph's Health Care London
P.O. Box 5777, Stn B
Room A2-014
London, ON N6A 4V2
Fax: 519-667-6844

RCDSO - Royal College of Dental Surgeons of Ontario - Letter of Standing

For Dentist applicants

  • RCDSO will issue a Letter of Standing to confirm College membership
  • The applicant is responsible for requesting the Letter of Standing and forwarding it to Medical Affairs at @email

CMO - College of Midwives of Ontario - Letter of Professional Conduct

For Midwife applicants

  • CMO will issue a Letter of Professional Conduct to confirm College membership
  • The applicant is responsible for requesting the Letter of ProfessionalConduct and forwarding it to Medical Affairs at @email
7. Confirmation of Liability Membership Coverage

CMPA - Canadian Medical Protective Association

For Physician applicants

  • Membership must be for Ontario

  • Proof of membership confirmation must be forwarded to Medical Affairs at @email

RCDSO - Memorandum of Liability Insurance Coverage

For Dentist applicants

  • RCDSO will issue a Memorandum of Insurance Coverage to confirm liability coverage

  • The applicant is responsible for requesting the Memorandum of Liability Insurance Coverage and forwarding it to Medical Affairs at @email

CMO - Letter of Malpractice Insurance Coverage

For Midwife applicants

  • CMO will issue a Letter of Malpractice Insurance Coverage to confirm liability coverage

  • The applicant is responsible for requesting the Letter of Malpractice Insurance Coverage and forwarding it to Medical Affairs at @email

8. Membership with the Royal College of Physicians and Surgeons of Canada or the Royal College of Family Physicians of Canada (Family Medicine Only)
  • Physicians applying for Professional Staff privileges must be a registered member and maintain membership with the appropriate Royal College.
9. Privacy and Confidentiality module, required eLearning and Cerner – PowerChart Training
  • The Privacy and Confidentiality module must be completed in order to request your corporate ID login. The instructions on how to complete this module are sent to you from Medical Affairs.
  • Once your CORPORATE ID has been set up, your department will email your login details which will provide instructions to complete required eLearning and PowerChart training required prior to your start date.
  • Completion of the modules is a requirement for the approval of hospital privileges.
10. Review the following information prior to submitting the application package
11. Save the following links to view the information listed below after your hospital start date

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To be Completed by the Department Contact

1. Chief Support Form - email completed and signed form to Medical Affairs

2. Request Corporate ID, Email, and Cerner Access

The Manager of Administration and Finance (Manager) or delegate will request the corporate ID, hospital email, and Cerner access for incoming professional staff using the Systems Access Request form. The request will be routed to Medical Affairs for review and approval.

Manager or delegate will copy and paste the login details into the standard template to ensure professional staff receive the full details related to the corporate ID, email, remote access, and ME (MyEducation), etc.

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Disclaimer

LHSC and St. Joseph's respect the privacy and confidentiality of the applicant's personal and professional information. Information provided in the application will be used for determining the applicant’s eligibility as a candidate for appointment.

Upon approval of the applicant's appointment, business address, as well as appointment and privileges information will be shared with the relevant corporate departments in order to facilitate access to corporate resources (for example, Admitting and Information Management). Only that information which is required will be shared, including our regional hospital partners in the surrounding London region (Tillsonburg District Memorial Hospital, Alexandra Hospital in Ingersoll, Woodstock General Hospital, Middlesex Hospital Alliance including Strathroy Middlesex General Hospital and Four Counties Health Services, and St. Thomas Elgin General Hospital).

All approved applications will be maintained by the Medical Affairs department for the duration of the appointment with LHSC and St. Joseph's. Upon termination, records will be kept in an archive filing system for 20 years.

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Preparing for your First Day

1. Hospital ID Badge

Complete the appropriate Photo Identification Request form prior to going to Human Resources/Security Services.

LHSC Photo Identification Request form

  • Victoria Hospital: Level 3, zone C, room C3-302 or C3-304, Monday to Friday from 8:00 a.m. - 4:30 p.m.
  • University Hospital: Lower level, zone C, room CLL-102, Monday to Friday from 8:00 a.m. - 4:30 p.m.

St. Joseph's Photo Identification Request Form

  • St. Joseph's Hospital: Level 0, zone B, room B0-401C

2. FirstNet Training

FirstNet (ED LaunchPoint) - To be completed prior to any Emergency Medicine rotations at any of the London or region hospitals (except South Huron Hospital Association or Listowel Wingham Hospital Alliance)

FirstNet (Tracking Board) - To be completed prior to any Emergency Medicine rotations at South Huron Hospital Association or Listowel Wingham Hospital Alliance.

3. N95 Respirator Fit Testing

Please ensure your N95 mask fit is to one of the masks the hospital carries

For more information on the current masks being carried and exact location and times of testing, please check the Occupational Health website for times and locations.

4. Urgent Messaging System Beep! (formerly pocket pagers)

LHSC and St. Joseph's has moved to a new citywide urgent messaging solution system called Beep!. This will eventually replace the more traditional pocket pagers used in healthcare and works with many devices including smart phones, wireless IP phones, and instant messaging products.

All Professional Staff will automatically be set up with a Beep account. To login to your Beep account, you will need to use your Corporate ID and password.

View the Information Technology Services (ITS) website for information on how to set your Beep account up.

I Want to Use a Pager Instead of Beep - If you prefer a traditional pocket pager, please contact Pager Management at @email or by phone at 519-685-8500 extension 53530.

If you choose to have a pocket pager, repairs and/or replacement pagers are available through the below Switchboard centres. Residents and Clinical Fellows are responsible for payment of a lost or physically damaged pager due to misuse.

  • University Hospital: ALL-203 Mail Room
  • Victoria Hospital: E2-510

* For urgent on-call pager repairs after hours, contact switchboard

If you will be on a leave of absence for more than two months, please return your pager to the centres listed above at either University Hospital or Victoria Hospital. If you wish to have the same pager number when you return from your leave of absence, please ask to have your pager number placed on "reserve".

5. Dictation Code

You must have your own personal and confidential dictating User ID number. To have your personal dictating user ID number arranged, please contact Transcription Services after you have attended the in class Electronic Health Records training.

  • London Health Sciences Centre - 519-685-8500 extension 35131
  • St. Joseph's Health Care London - 519-646-6000 extension 65584

Dictation System Instruction Sheet

6. Scrub Suits

Please Note: Due to COVID-19, scrubs are limited. Please return your scrubs to the machines for laundry after every shift.

Scrub Suits are dispensed using the ScrubAvail ScrubEx dispensing system. The system is activated by using an access card and works as a credit/debit system. *Due to Covid-19 only those working in a role that required the use of the scrub program will be approved.

LHSC Scrub uniforms 
Physicians, Dentists and Midwives, please complete the attached Scrub Uniform Request form and bring to the linen department.

 

University Hospital

Victoria Hospital

Linen Dept.

Room C1-307

Monday to Friday
7:30 am - 8:30 am & 1 pm - 1:45 pm

Room A1-400
Monday to Friday
7:30 am - 9 am & 1 pm - 2 pm

St. Joseph's
The scrub deposit fee is $50 (cheque, money order, or credit card). Once your payment has been made, please bring your receipt to the Customer Support Centre. 

St. Joseph's Hospital

Cashier's Office

Room B0-068

Monday - Friday
8 am – 4 pm

Customer Support Centre

Room A0-012

Monday - Friday
8 am – 4 pm

Scrub suits are used in hospital settings as a protection to the patient as well as the employee. To ensure we continue to treat scrubs as more than a "uniform", it is imperative they not be worn outside the building while coming to the hospital or going home at the end of the day.

7. Radiation Monitoring Badges (Dosimeters)

To receive a radiation monitoring badge (Dosimeter), please complete the Dosimeter Request Form. The request form will then need to be emailed to radiation_Safety@lhsc.on.ca at least one week in advance of your start date. Radiation Safety will issue the dosimeter to the appropriate badge board.

8. Ensure you have access to the computer systems

  • Corporate ID and Outlook Email - login details will be sent from your department adminstrator.
  • Cerner PowerChart - Instructions on how to complete and register for this training will be included in the document sent to you with your corporate ID and email details.

9. Parking

City Wide Parking - you will need to visit both LHSC and St. Joseph's to set up City Wide Parking. LHSC uses a transponder and St. Joseph's uses a swipe card.

Please complete parking application. Have this completed prior to arriving as only one person is permitted in the office. You must have vehicle information,make, model and license plate on the form and to register it with the parking office.

  • Step 1 - Please visit one of the LHSC parking office locations listed below. Let them know you will require city wide parking. They will arrange the monthly fee payment (can be automatically deducted from your pay) and provide you with a transponder that will require a $20 deposit which is refundable upon the return of the transponder. Victoria Hospital and University Hospital require a transponder for parking.

University Hospital
Parking garage adjacent to the main hospital building (parkade 4)
Open 24 hours, 7 days/week

Victoria Hospital
Parking Garage adjacent to the London Regional Cancer Centre (parkade 8)
Open 7:30 am - 8 pm, Monday to Friday

Please contact the LHSC parking office for monthly costs. 519-685-2709.

  • Step 2 - To obtain access to parking at the St. Joseph's site, you will need to go to St. Joseph's Security Services at the 268 Grosvenor site. They will provide you with at St. Joseph's ID badge (if you don't already have one) which will need to be programmed to let you into the parking garages. All St. Joseph's sites require the use of the hospital access card for parking.

St. Joseph’s Hospital
Grosvenor Street Security Services for ID badge
Parking office is at the exit of the Grosvenor St. garage

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