Nevada Standardized Initial Application

Please carefully read the following instructions regarding the attached application.

  1. This application must be typed or legibly printed. You may attach a C.V., but this form must be completed. If more space is needed than provided, attach additional sheets. Please account for all time periods since medical school or AHP Education.
  2. All providers are to use this application.
  3. Please maintain a copy of your completed application for your files.
  4. As a convenience to the applicant and to decrease unnecessary duplication, this appointment application form is utilized by several healthcare entities in Northern Nevada. If you apply for appointment and/or clinical privileges at any other facility, it is your responsibility to make a copy of your completed application and to assure that it is received by the Medical Staff Services or credentialing office of each entity to which you wish to apply.
  5. Please be aware that each facility maintains certain facility-specific requirements, including application fees, and the submission of the completed application merely signifies your interest in being considered for appointment and privileges. It does not mean that you will be, or have been, granted privileges, membership or access. Upon receipt of your application, each facility will communicate directly with you regarding specific requirements within that facility’s application process, including possible application fees, specialty criteria, privilege application forms, etc.
  6. Please allow 120 days for the processing of your application.

Renown Health:
Hometown Health
Renown South Meadows Medical Center
Renown Rehabilitation Hospital

Please send only one copy for Renown entities to:
Attn: Medical Staff Services
1155 Mill Street
Reno, NV 89502
Phone: 775-982-4270
Fax: 775-982-4575

Download the Application Document and follow the directions contained within the document.

To download the document click on the document type link below.

Medical Staff Services Application

The document must be typed, signed and dated.

Return the document to a participating healthcare entity via the Postal Service. Questions? Call 775-982-4270.