Medical Staff Services: Pre-Appointment Information

Welcome to the University of Michigan Hospitals and Health Centers. This webpage provides you with documents and forms to get you through the credentialing and privileging process – one of the first steps in your appointment process.

To be completed and sent to State and Federal licensing organizations:

• Michigan Department of Community Health - Medical Doctor Licensure Application Packet
• Michigan Dept of Community Health - Osteopathic Medicine and Surgery
• Michigan Dept of Community Health - Dentistry
• Michigan Dept of Community Health - Psychology
• Michigan Dept of Community Health - Optometry
• Michigan Department of Community Health - Controlled Substance License Application
• Drug Enforcement Agency (DEA) - Controlled Substance License / DEA
  • Click here for information regarding the DEA Fee Exemption

To be completed and sent to Medical School, Training Institution, or Previous Hospital:

• Dentist
  • Certification of Dental Education for Dental School Graduates
  • Certification of Postgraduate Training for Dentist

To be completed and sent to Department Contact for submittal to Medical Staff Services:

• Identity Verficication Form
• Directions for Completion of the Identity Verification Form
• Background Check Information, Consent and Disclosure Form
• Lawsuits or Notices of Intent
• Code of Conduct Statement
• Practitioner Certification of Receipt and Attestation - Medicare/Champus
• Delineation of Privileges

MAPS Enrollment

• PA 0248 SB 166 Requires prescribers to obtain and review a MAPS report prior to prescribing or dispensing to a patient a controlled substance exceeding a three-day supply.  Prescribers must also be registered with MAPS as a condition of licensure.

• MAPS registration page can be found at: https://michigan.pmpaware.net/identities/new.

• Individual prescribers can call (844) 364-4767 to confirm enrollment status.

• There is a required learning module to be completed. It is found in Cornerstone Learning. Look for code OCAX-28401 MAPS (Michigan Automated Prescription System) Registration Attestation (OCAX-28401-WBT, 1.0) to register for the module.

For more information on MAPS registration and any other opioid legislation concerns, visit the Pain Management website at:  http://www.med.umich.edu/i/pain/ or contact the Michigan Medicine Pain Management Coordinator at UMHS-Pain-Management@med.umich.edu.

Additional documents will require review upon appointment. These include:

• Medical Staff Bylaws
  
• Medical Staff Rules and Regulations
• Notification of Practitioner Rights
  
• Medical Staff Policies
  
• Administrative Rules of the Michigan Board of Medicine