Medical Staff On-Boarding Gateway

Getting started at the nation’s children’s hospital.

Congratulations on your new position and welcome to Children’s National.  We are delighted that will be joining our family and we look forward to you sharing your talents with us. 

I will be serving as your pre-hire liaison and will keep you informed about what to expect during this process.  You will be required to provide information and documents for Human Resources, Occupational Health, Medical Staff Credentialing and Academic Appointments.  Within the next few days, I will send a checklist with your specific requirements that will help you track your own progress.  In addition you will be able to access an online status report for up-to-date information regarding your on-boarding at this website.  

For your convenience, our website contains a page with links to documents and websites that are referenced in your checklist.  Please click here for an overview of what you might expect. 

This is an extensive process, but we will be here to help you through each step.  As we progress, you will also have the services of an administrative liaison, and a clinical liaison. 

Please do not hesitate to contact me with questions or concerns via phone or e-mail.  I will be checking in with you frequently as we progress. 

I look forward to meeting you soon.

Susan Pfennig
Senior Manager, Medical Staff Services

Human Resources

Human Resources

ActivitySpecial Instructions

On-line Application for Employment Completed

This application was completed prior to your receipt of your letter of offer.
Or
You have not yet completed this online application. You will receive instructions from Recruiting in Human Resources along with the link to complete this application.

Contact: 301-244-4826 or 301-244-4838.

On-line Authorization for Release of Information Form Completed

Part of the application

On-line Questionnaire Completed

Part of the application

Federal and State Tax Forms

A link to complete these forms will be sent via email from our applicant tracking system, then verified during your appointment with Human Resources. 

PAR/New Hire/Rehire Form

A link to complete these forms will be sent via email from our applicant tracking system, then verified during your appointment with Human Resources.

Confidentially Statement

A link to complete these forms will be sent via email from our applicant tracking system, then verified during your appointment with Human Resources.

Form I-9, Employment Eligibility Verification Form with Lists of Acceptable Documents

The documents that you will be using to show proof of employment eligibility should be presented to the HR Representative on the initial face-to-face visit with Human Resources and should be originals not copies.

Direct Deposit Form

This document is to be completed by you and presented to Human Resources along with documentation appropriate for the account(s) that the check is to be deposited

 Employee IDOnce you have completed all of your Human Resource and Occupational Health requirements, you will receive a clearance form from Occupational Health (main campus) and present it in person at the parking office. The parking office will process your photo ID.
 Parking FormParking is available on site for physicians with 50% or greater patient time, as well as NPs and PAs. For those who do not qualify for onsite parking there are a number of options to select from. Please download the form and complete it. You can fax this form to the parking office 
 Online OrientationIn your letter from  Recruiting, you received instructions on accessing the Children’s National website, together with a username and password. This online orientation replaces the in-person full day orientation previously held for all new employees. This online orientation will take four hours, and needs to be completed prior to the Thursday before your Monday start date.  

Please contact Recruiting at 301-244-4826 or 301-244-4838. If you have any difficulty accessing this orientation program.

Occupational Health

Occupational Health

The following is a listing of items that must be satisfied prior to employment at Children’s National Medical Center.  These items are required by the District of Columbia Municipal Regulations Title 22 as well as by Children’s Hospital’s Occupational Health.

ActivitySpecial Instructions

Employee/Volunteer Medical History "Initial Visit" Form

Download Occupational Health Forms

A Latex Allergy Questionnaire

Download Occupational Health Forms

A Hepatitis B Vaccination "Consent/Declination Form"

Tuberculin skin test Form-top half of form

Download Occupational Health Forms
A pre-employment
Health Screen

You can choose to have a private physician conduct a pre-employment screening instead of Children’s Occupational Health (OH).  If you choose to have the private physician complete the screening, please utilize the attached Employee Health Form to satisfy the screening requirement. You can bring in your own Private Physician’s physical exam form. This document can be used to satisfy the request of a pre-employment health screen.  

Occupational Health Forms

Proof of two TB skin
tests or T-Spot
You are requested to provide Proof of 2 TB skin tests being placed and read within the past 12 months. OH will place the 2 TB skin tests if you can not provide proof. The TB skin tests have to be placed at least 7 days apart so allow extra time for placement and reading. If you have a known positive TB skin test, an X-ray will be ordered and conducted by Children’s Radiology Department. If you have a copy of a previous X-ray within (12), this will satisfy the X-Ray requirement. A T-spot done within the previous twelve months is accepted as an option to a 2 step PPD, or a T-Spot can be done by OH.

Proof of immunization of Measles, Mumps, Rubella and Varicella (Chickenpox)

A history of chickenpox; OR 2 varicella vaccines; OR lab report of titers are acceptable. If born before 1957, only 1 MMR is requested. If born after 1957, 2 Measles; 1 Mumps, 1 Rubella OR  2 MMR’s is requested prior to your employment date.

A satisfactory drug screen

This drug screen is processed by Children’s Occupational Health Office. Alternative arrangements can be made to have your drug screen completed off-site at a Quest Diagnostics Lab. A Quest Diagnostics Lab form will be sent to you via FedEx. Off-site drug screen results takes approximately five (5) to seven (7) days to be received by Children’s OH.

Academic Appointment

Academic Appointment

ActivitySpecial Instructions

Academic Application Process       

Your basic information will be entered by Susan Pfennig into the Academic system, which will launch your application. You will  receive an e-mail with further instructions on completing the progress. Arlene Gendron in Academic Affairs will help guide you  through the process.

Contact:
Arlene Gendron: agendron@cnmc.org
Medical Staff Appointment

Medical Staff Appointment

Items in bold indicate multi-jurisdictional requirements.

Please send all items listed in this section directly to the medical staff office. Please do not include them with the materials you are sending to Human Resources 

Medical Staff Services
Children's National Medical Center
801 Roeder Road
Suite 600
Silver Spring, MD 20910
Phone: (301) 565-4279
Fax: (301) 565-4284

ActivitySpecial Instructions

Medical Staff Bylaws

Reference material. In your medical staff application, you will attest that you agree to abide by the Medical Staff Bylaws and Policies and Procedures. These documents do not need to be printed.

Medical Staff Bylaws PDF

Medical Staff Policies and Procedures

Reference material. In your medical staff application, you will attest that you agree to abide by the Medical Staff Bylaws and Policies and Procedures. These documents do not need to be printed.

Medical Staff Policies and Procedures PDF

Completed and signed Application for Appointment to the Medical Staff

Application for Medical Staff Appointment

Completed and signed Delineation of Clinical Privileges

The appropriate delineation of privilege form will be sent to you as an attachment to this document 

Document attached to this e-mail

Completed CAQH application

In addition to the Medical Staff application, you will be required to submit a CAQH application for provider enrollment purposes.

Current Updated curriculum vitae

Please submit an updated curriculum vitae.

Copy of DC License

Obtain the license application and instructions on the website. This should be done as early as possible in the process.

District of Columbia License

Health Professional Licensing Administration
DC Department of Health
899 North Capitol Street, NE
Washington, DC 20002
Phone: (202) 442-5955
Fax: (202) 442-4795

Copy of DC Controlled Substance Certificate

Obtain the CSC application and instructions on the website. You will not be able to submit this document until you have received your DC License.

DC Controlled Substance Certificate

DC Controlled Substance Certificate
DC Department of Health
899 North Capitol Street, NE
Washington, DC 20002
Phone: (202) 442-5955
Fax: (202) 442-4795

Copy of Maryland License

Obtain the license application and instructions on the website. This should be done as early as possible in the process.

Maryland License

Maryland License
Board of Physician Quality Assurance
State of Maryland
4201 Patterson Avenue,
P.O. Box 2571
Baltimore, MD 21215-0095
(410) 764-4777

Copy of Maryland Controlled Substance CertificateObtain the CSC application and instructions on the website. You will not be able to submit this document until you have received your Maryland license.

Maryland Controlled Substance Certificate

Maryland Controlled Substances Registration
State of Maryland 
Department of Health and Mental Hygiene
Division of Drug Control
4201 Patterson Avenue
Baltimore, MD 21215-2222 
(410) 764-2890
Copy of Virginia LicenseObtain the license application and instructions on the website. This should be done as early as possible in the process.

(Please note there is no CSC for the State of Virginia)

Virginia License

Virginia License
Commonwealth of Virginia
Board of Medicine
6606 W. Broad Street, 4th floor
Richmond, Virginia 23229-5005
(804) 662-9908
Copy of DEA Registered in DCDEA Registrations are required for all jurisdictions where you practice. If you have a current registration, you may wait until your start date to move your registration. If you are practicing in more than one jurisdiction, please apply for additional registrations

If you are obtaining your first registration, you will be required to have the state license and controlled substance certificate prior to obtaining the DEA certificate for that jurisdiction.

DEA Registration

DEA Certificate
US Dept. of Justice 
Drug EnforcementAdministration 
P.O. Box 2083
Central Station
Washington, DC 20005
1-800-882-9539

Copy of DEA registered in MDDEA Registrations are required for all jurisdictions where you practice. If you have a current registration, you may wait until your start date to move your registration. If you are practicing in more than one jurisdiction, please apply for additional registrations

If you are obtaining your first registration, you will be required to have the state license and controlled substance certificate prior to obtaining the DEA certificate for that jurisdiction.

DEA Registration

DEA Certificate
US Dept. of Justice 
Drug EnforcementAdministration 
P.O. Box 2083
Central Station
Washington, DC 20005
1-800-882-9539 
 

Copy of DEA registered in VADEA Registrations are required for all jurisdictions where you practice. If you have a current registration, you may wait until your start date to move your registration. If you are practicing in more than one jurisdiction, please apply for additional registrations

If you are obtaining your first registration, you will be required to have the state license and controlled substance certificate prior to obtaining the DEA certificate for that jurisdiction.

DEA Registration

DEA Certificate
US Dept. of Justice 
Drug EnforcementAdministration 
P.O. Box 2083
Central Station
Washington, DC 20005
1-800-882-9539 

Copy of professional school diplomaRequired for provider enrollment application. 
Copy of Internship, Residency, Fellowship certificatesRequired for provider enrollment application.
Copy of ECFMG certificate (if applicable)If foreign trained
Copy of current Board certificate (if applicable)Board Certification is required within six years of completion of residency or fellowship training. 
Statement of Physical and Mental CompetenceMust demonstrate a physical examination and negative TB test within the past 24 months. 

Document attached to application
Three Peer References Provide the names and contact information, e-mail addresses preferred, for three professional references. One of the references must be from the most recent chairman, chief, or training program director. 

Document attached to application
Photo and Photo ID Required

Provide a passport size photo.

In addition, we need a photo ID that is a clear copy of your driver’s license, passport or other government issued identification. 
NPI Number

NPI numbers can be obtained or edited by going to the NPPES website.

Shortly before your arrival at Children’s, please edit your NPI number the NPPES website. 

Please update your taxonomy and addresses according to the instructions noted to the right. 

Do not use any punctuation marks while filling out the information such as Dr.John.Smith

Provider Business Practice location: 
111 Michigan Ave NW
Washington DC 20010

Provider Business Mailing Address: 
PO Box 37215
Baltimore, MD 21297-7215 Ensure that your taxonomy reflects your current status/specialty

Application FeeNon-refundable $100 application fee made payable to Children’s Hospital Medical Staff Fund.
Provider Enrollment

Provider Enrollment

Please send all items listed in this section directly to the medical staff office. Please do not include them with the materials you are sending to Human Resources

Medical Staff Services
Children's National Medical Center
801 Roeder Road
Suite 600
Silver Spring, MD 20910
Phone: (301) 565-4279
Fax: (301) 565-4284

 
ActivitySpecial Instructions

DC Medicaid Application

Pages requiring signature are attached.  Please sign where indicated in blue ink but do not date these signatures. The full application will be completed by Medical Staff Services.  If you would like a copy of the application, please let us know. 

Documents Attached

VA Medicaid Application

Pages requiring signature are attached.  Please sign where indicated in blue ink but do not date these signatures. The full application will be completed by Medical Staff Services.  If you would like a copy of the application, please let us know. 

MD Medicaid Application

Pages requiring signature are attached.  Please sign where indicated in blue ink but do not date these signatures. The full application will be completed by Medical Staff Services.  If you would like a copy of the application, please let us know. 

Medicare Application(s)

Pages requiring signature are attached.  Please sign where indicated in blue ink but do not date these signatures. The full application will be completed by Medical Staff Services.  If you would like a copy of the application, please let us know. 

Completed
CAQH
application

In addition to the Medical Staff application, you will be required to submit a CAQH application for provider enrollment purposes.
Electronic Medical Record- Web Based Training and Assessment Access

Electronic Medical Record- Web Based Training and Assessment Access

Complete the Web Based Training Modulesthen the checked CHEX Assessments.

Web Based TrainingCHEX Assessment

TRACKS (PowerChart) for Inpatient Providers

TRACKS FOR INPATIENT PROVIDER ASSESSMENT

Web Based Training
Username:
Password:

CHEX Assessment:
Username:
Password:

TRACKS (PowerChart) Overview for Outpatient Staff and View Only Staff

TRACKS (PowerChart) View Only Assessment

Web Based Training
Username:
Password:

CHEX Assessment:
Username:
Password:

TRACKS OR (SurgiNet) for OR Providers

TRACKS OR (SurgiNet) for OR Providers & Nurses Assessment

Web Based Training
Username:
Password:

CHEX Assessment:
Username:
Password:

TRACKS EMTC (Firstnet) for Providers

TRACKS EMTC (Firstnet) for EMTC Providers Assessment 

Web Based Training
Username:
Password:

CHEX Assessment:
Username:
Password:

eCW for Providers

eCW Assessment for Providers

Ambulatory EHR training


Online Employee Resources

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Get access to important tools and information online from home or work. Stay up-to-date on email, benefits, and much more!

Employee Resource Center

CNID Self Service

A system for onboarding employees and granting access to Children’s systems.

CNID