MEMORIAL UNIVERSITY MEDICAL CENTER
ON-LINE REAPPOINTMENT APPLICATION INSTRUCTIONS
Below are the instructions to complete the application. Please complete by due date listed on your cover memo
and invoice. If you have any questions or run into problems, please call System Credentialing, 350-6664 between
8:00 AM and 5:00 PM Monday-Friday.
The application, Memorial forms, and privileges are all online. The only items you need to return are: Georgia
Statewide Criminal Background Consent and a current CV (requested but not required). Send these items to
Memorial Credentials via our secure fax number 350-6509. Note: If you have any new, pending, or closed
malpractice cases in the last two years, you will need the details of those cases to complete Schedule B of the
online application.
1. Go to your internet browser and enter in address: https://www.memorialhealth.com/reapp/default.aspx
If you have received an e-mail, the link is included in the e-mail and on the letter.
2. This is the screen you will see. Enter in your SSN, format 111-11-1111 and select continue button in lower left
corner.
3. The next screen is to select your privileges (if applicable). Follow the instructions. After completing it will automatically
take you to the application. The privileges are e-mailed directly to us.
If you do have
privileges, they
will be listed
here.
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4. This page gives you some brief general instructions. From the dropdown list, select, create a New
Application (if first time) or Create a New Application, pulling information from most recent (if you have
completed the on-line application before).
5.
This is the screen you will see. Please note the application will TIME OUT in 20 minutes if not in use for
security purposes. The application follows the Georgia Uniform Application. There is no need to read the Georgia
Uniform Official Instructions. We have built the application to prompt you for the information needed. Place your
mouse over the Section title and click. This will take you to that part of the application. After each Reappointment
Section, you have to select the button in lower left corner. Click here to accept and Go to Next Section or Cancel
and Return to Menu. Once you have answered questions and accepted, the Menu screen will show the
Reappointment Section Completed. Continue on to the next Reappointment Section. Section 8, Schedule A, and
Schedule C are attestation and electronic signature.
Section 3-6:
Under part C – Do Not include
Memorial CME. Already on file.
Under part D – If no changes, do
not need to list
6.
Update Your Information. This is just like the Profile that was always included in your reappointment. Our
credentialing software populates the information. If everything is correct, click on Information Current. ONLY
NOTE CHANGES. Once you have made changes or if everything is correct, click on button in lower left corner:
Click Here to Accept and Go to Next Section.
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Insurance and Claims History Section and Reappointment Section 3, 4, 5, and 6 questions are defaulted to NO. If you need
to modify, click YES on applicable question. Click button in lower left corner for each of the sections to accept changes and
move to next section.
7. Application Section 7 is Attestation Questions. Please review for any changes. You must answer these Yes or No. If
you answer Yes on any, question, an explanation box will appear. You will have to complete the explanation box in order to
save and move to next section.
8. Schedule B: Malpractice Claims. If you have no malpractice claims, select button This does not apply
If you have pending claims, click on Add a New Schedule B button. If you need additional Schedule B forms, click on
button in lower left corner to go back to Schedule B Menu. You can continue to add new Schedule B forms.
Schedule B: Update AND include in this application
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9. CME Form. Please complete the top portion of the form and complete attestation on CME/CE for license (if
applicable). Accept by clicking button in lower left corner. If we show that you are short Error prevention/patient
safety CME (two hours every two years required), you will be prompted to complete the Memorial online post-test.
If you need more than one hour, you will also be directed to the AHRQ site for an additional hour. If you are short
CME, do not hold up your application. You can provide documentation up to 30 days prior to your reappointment
date.
10. Continue this same process for all the sections. Once all sections are complete, you have the option from the
MENU to View and Print Application.
When Section is completed, it
will be listed as completed. If
answers are missing or required, it
will not show as completed.
11. The printed version mirrors the Georgia Uniform Application. Select Print Application button. Once you have
printed the application select the Previous button to take you back to the application. Select button in lower left
corner Submit Application for Processing as shown in item 10 above.
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12. This is the next screen you will see. If you need error prevention, you can select the Memorial Error
Prevention CME. An e-mail will be sent to the medical staff office of your post-test. If you need more
than one hour, you can also select AHRQ. Each of the Spotlight cases from 2007-2008 are recognized for
one hour of EP CME.
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INSTRUCTIONS FOR SAVING AND RETURNING TO MUMC APPLICATION TO COMPLETE
You can always save your application and come back to it later. Please note that you must complete the Section
you are in or the changes to that Section will not be saved. Follow instructions 1-4 on pages 1 & 2. From the
drop-down list, select Update Existing Application with corresponding date and time. You can continue with
instructions 5-12. There are no limits to the times you can save and return to the application.
QUESTIONS: MUMC System Credentialing Office: 350-6664, 8:00AM-5:00 PM, Monday-Friday
Yvonne Warbington: 350-6652
Stephanie Byrd: 350-8946
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