Credentials Application Process


Step 1
HSHS facilities use an online application process. Complete and submit form below.
 
Membership/Privileges Application Request Form
Provider Information 
(All fields are required)
Location:



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Use this space to note any issues we need to be aware of regarding this application.
Enter security code:
Security code

 
Step 2
Once Medical Staff Services receives your request form you will receive an email with a link to the online application website, your username and password and a list of the applicable forms required. 
 
Step 3
Complete and submit the online application and upload any supporting documentation (licenses, malpractice coverage, etc.), including the Illinois State Credentialing Application and privileges forms. You may also scan and email documentation to Medical Staff Services or fax to (217) 525-5673 (St. John’s), (217) 464-3144 (St. Mary’s) or (217) 324-8670 (St. Francis and Good Shepherd).
 
Step 4
One non-refundable fee of $300 is due at the time of application, regardless of the number of HSHS facilities applied to. Please make check payable to HSHS St. Elizabeth Hospital CVO and send to:

HSHS St. Elizabeth Hospital
180 South Third Street, Suite 400
Belleville, IL  62220

 
Questions?
Call St. John's Medical Staff Services at (217) 757-6161 or fax (217) 525-5673.  
Call St. Mary's Medical Staff Services at (217) 464-5215 or fax (217) 464-3144.
Call St. Francis Medical Staff Services at (217) 324-8791 or fax (217) 324-8670.
For Good Shepherd, call or fax St. Francis's Medical Staff Services at the numbers above.  

 
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