Temporary privileges 2026

1. Click ‘Get Form’ to open the Temporary Request form in the editor.
2. Begin by entering your personal information, including your name and the department for which you are requesting privileges.
3. Provide a detailed justification for why temporary privileges are necessary. Check the appropriate box that applies to your situation, such as locum tenens or emergency patient care need.
4. Attach all required documentation, including your professional license, CV, DEA (if applicable), and proof of current malpractice insurance coverage.
5. Complete and sign the Delineation of Privileges section, ensuring it is approved by the appropriate Department Chair.
6. Finally, review all entries for accuracy before submitting the form electronically through our platform or printing it for faxing to the Medical Staff Office.

Start filling out your Temporary Request form today on our platform for free!