Credentialing Process
If you do not have a Utah State License, you will need to apply to FCVS first. Go to step 1. If you do have a Utah State License, then go to step 2.
- 1. FCVS
- This process has been known to take the most amount of time in your credentialing process and could possibly take up to 150 days, so you should start immediately on this process. The link is located on the left-hand side under FCVS.
- Processing time: up to 150 days
- 2. Medical Staff Office Privileges
- Click on the Medical Staff Office privileges. Complete the APPCENTRAL STUB RECORD and send it back to jeffrey.mann@hsc.utah.edu.
- Processing time: 4-5 months
- 3. Utah State License
- Click on the Utah State Physicians License on the left-hand side. You are now at the Utah Division of Occupational and Professional Licensing. On the left-hand side under DOPL Online Services, click on Apply for a License and follow the instructions. (Note: if you already have a Utah State License, you will also need the Utah State Controlled Substance License prior to applying for your DEA.)
- You will note that your Utah State Physicians and Surgeons license will have a series of numbers followed by -1205. When you receive your controlled substance license, it will look exactly like your original Utah State License only with a second series of numbers which are the same numbers as your Physicians and Surgeons with a -8905. That is the controlled substance portion of your Utah State License.
- Processing time: Once FCVS has been received, 1-2 months
- 4. DEA License
- Click on the DEA License and follow instructions. You cannot apply for a DEA License unless you already have your Utah State and Controlled Substance License.
- Processing time: 1 month after receipt of controlled substance license
- 5. UUMG Provider Info Sheet
- Click on UUMG link located on the left hand side. Under Welcome you will see a box that says, “What’s New at UUMG” click the Download link and complete the Provider Information Sheet. Download, Print the form and return completed form to Jeff Mann. If there are areas you are not sure about leave blank or contact Jeff Mann at: jeffrey.mann@hsc.utah.edu
- Processing time: 1 month
- 6. VA Application -Vet PRO
- Complete form, print and return to Jeff Mann.
- Processing time: 1 month
- 7. VA Application II
- The VA requires this application to be completed as well. Print out and return to Jeff Mann at: jeffrey.mann@hsc.utah.edu
- Processing
time: 2 months
- 8. VA Application III
- The VA requires this application to be completed as well. Print out and return to Jeff Mann at: jeffrey.mann@hsc.utah.edu
- Processing time: 2 months
- 9. ACLS and BLS Card
- You will need to send me a copy of your BLS and ACLS cards. You may scan and email to: jeffrey.mann@hsc.utah.edu
- Processing time: 1 week
- You will need to send me a copy of your driver’s license or passport photo along with your social security card. You may scan and email to: jeffrey.mann@hsc.utah.edu
- Processing time: 1 week
- 11. Curriculum Vitae
- You will need to send me a copy of your CV. You may scan and email to: jeffrey.mann@hsc.utah.edu
- Processing time: 1 month
- 12. Early Entry CV
- Please complete the Early Entry CV. The top four boxes are for internal use only. Start with your name and work on down. An example of proposed track would be like tenure or clinical track. Proposed ranks would be: Instuctor, Assistant Professor, Associate Professor or Professor. Do not fill in the requested entry completion date. However, please complete the “Faculty Member’s Current Contact Information. Please attach this with your CV if you haven’t already sent your CV in. Click here to complete: You may scan and email to: jeffrey.mann@hsc.utah.edu
- Processing time: 1 month
- 13. Criminal Background Check and Drug Testing
- If you did not complete your residency at the University of Utah, You will need to complete a criminal background check and drug testing. Please contact Jeff Mann at: jeffrey.mann@hsc.utah.edu in order to set that up.
- Processing time: 1 month
- 14. I-9 forms
- If you did not complete your residency at the University of Utah, you will need to complete an I-9 form. Schedule this with Vicky Larson at vicky.m.larsen@hsc.utah.edu
- Processing time: 1 month
- 15. Immunizations
- I will need a copy of your immunizations including dates of TB, MMR, and Hepatitis B. This information is also required in your medical staff application packet. You may scan and email to: jeffrey.mann@hsc.utah.edu
- Processing time: 1 month
- 16. Master Summary Document
- Click on Master Summary Document and use as a template. You may copy over this. It is a WORD document. I will need this form returned to me in Word format. You will be updating this form from time to time so please DO NOT SEND IT IN PDF FORMAT. You may send as a word document to: jeffrey.mann@hsc.utah.edu
- Processing time: 1 month
- 17. Medical School Diploma
- I will need a copy of your medical school diploma. Please scan and email to: Jeffrey.mann@hsc.utha.edu
- Processing time: 1 month
- 18. NPI
- I will need a copy of your NPI number. If you have the email that you received your NPI number from or some other documented form it would be appreciated. Please attach and email your NPI information to: jeffrey.mann@hsc.utah.edu
- Processing time: 1 month
- 19. Letters of recommendation
- The University requires letters of recommendation for your faculty appointment. These letters should come from individuals of equal or higher rank than yourself. The following is the number of letters required for faculty appointment:
-
- Instructor or Assistant Professor:
- (2) letters from within the department and if trained at the University of Utah (2) letters from outside the Department. If not trained at the University of Utah then (2) letters from outside the institution.
-
- Associate Professor or Professor:
- (3) letters from within the University of Utah and (3) letters from outside the University of Utah.
- The letters should contain
language supporting your faculty appointment. It should speak somewhat of
your teaching, clinical skills, any scholarly work and administrative work. (Note: this is part of your faculty appointment process; letters should be requested ASAP.)
- Letters should be addressed to:
- Dr. Michael Cahalan, M.D.
- Professor and Chair
- Department of Anesthesiology
- 3C-444 SOM
- 30 N 1900 E
- Salt Lake City, Utah 84132
- Letters may also be scanned on department letterhead and emailed to: jeffrey.mann@hsc.utah.edu
- Processing time: 4 months
10. Drivers License or passport photo and social security cards