Affiliates Credentialing Checklist

To help ensure that your application is processed as quickly as possible, please gather the following information before the credentialing process begins:

  • Full legal name
  • Date of birth
  • Social Security Number
  • A copy of your government ID
  • Curriculum Vitae that includes a comprehensive work history
  • Current California State Medical (or other professional) License(s)
  • Valid DEA certification, if applicable
  • Medical or other professional school(s) attended
  • Residency
  • Fellowship(s)
  • Previous affiliations prior to UCSF Medical Staff appointment
  • Current board certifications
  • Certificate of Insurance (COI) for your current professional liability insurance
  • Professional liability claims history
  • Continuing medical education
  • Letters of Reference (including Service Chief Review) that attests to clinical competence and ethical character of the applicant