Dear Applicant:

Thank you for requesting an application for medical staff membership and/or clinical privileges at Garfield Medical Center. We are happy to enclose an application. The Medical Staff of Garfield Medical Center has adopted the California Participating Physician Application as recommended by the California Medical Association. You may use this application for any healthcare organization that accepts it. You may submit a copy as long as the signatures on Pages 8 and 9 are originals. Please call the Medical Staff Office if you would like the application on a disk and we will be happy to provide it.

Checklist of the application:

1. All forms must be completed and returned with the application.

- The California Participating Physician Application/Application Addendum can be filled online and we will have your electronic file OR you can download the form and return it to our office

- Discrimination Policy

- Infection Prevention Policy 

- The Privilege Form can be downloaded from the website

2. Nonrefundable application fee in the amount of $400 (payable to: GMC Medical Staff)

3. Current copies of your California License, DEA, X-ray Supervisor Certificate, and a list of the continuing medical education courses you have completed during the previous two years (CME not required if you have completed residency or fellowship training or have obtained board certification within the last two years).

4. Two (2) forms of identification that includes your name, picture and signature (such as a driver’s license and hospital identification badge) plus a wallet size photograph.

5. Evidence of current professional liability insurance in minimum amounts of $1 million and $3 million.

6. If you are requesting privileges in Anesthesia, you must provide evidence of current BLS or ACLS certification.

7. If you are requesting privileges in EMERGENCY MEDICINE, you must provide evidence of current BLS, ACLS and PALS certification. Your signature on the application signifies you agree to be bound by the terms of the Medical Staff Bylaws, Rules, Regulations and applicable policies and procedures. The Credentials Committee may conduct an interview. If an interview is deemed to be necessary, the Committee will notify you in writing as to the date, time and place. Please call the Medical Staff Office (626-307-2120) if you have any questions or require assistance in completing the application.

MEDICAL STAFF OFFICE
Garfield Medical Center
525 N Garfield Ave.
Monterey Park, CA 91754