Medical Staff Applicants
Privileging Applications
Thank you for your interest in joining the Sonoma Valley Hospital Medical Staff. If you have not already done so, please contact our Medical Staff Office at medstaff@svh.com or 707.935.5141 with the following information.
- Your full name
- Your email address
- Your phone number
- The medical specialty privileges for which you wish to apply
- The name of any existing medical group or local office practice you anticipate joining
- Anticipated start date
Then, complete the background investigation release, application, Initial Appointment Attestation and Hospital Orientation Attestations below and submit to Medical Staff Services at 347 Andrieux Street, Sonoma, CA 95476.
1. BACKGROUND INVESTIGATION RELEASE
Download the background investigation release and submit with your completed application and accompanying materials.
2. MEDICAL STAFF APPLICATION
Download the California Participating Physician Application, Addendums B and C, Attachment D, and TB Attestation below and submit to our Medical Staff Office with copies of the following:
- State or Federal photo ID (driver’s license or passport)
- State Medical License
- DEA Certificate
- Board Certification
- Professional Liability Fact Sheet
- Curriculum Vitae
- ECFMG (if applicable)
- Core Privilege Forms (these will be sent to you by the Medical Staff Coordinator)
- Application fee of $250 payable to the SVH Medical Staff Education Fund
3. INITIAL APPOINTMENT ATTESTATION
As part of the application process you will be asked to attest that you have been furnished with a copy of the following materials. Please return the signed Initial Appointment Medical Staff Attestations with your completed application. Links to downloadable PDF versions are provided below:
- California Participating Physician Reapplication
- SVH Code of Conduct
- Medical Staff Tuberculosis Attestation Form
- Restraint Policy
- SVH Pain Management Policy
- HIPAA handbook
4. HOSPITAL ORIENTATION ATTESTATION
As part of the application process you will be asked to attest that you have been furnished with a copy of the following hospital orientation materials. Please return the signed Orientation Attestation Page with your completed application.
5. PRACTICE GUIDELINES FOR SEDATION AND ANALGESIA BY NON-ANESTHESIOLOGISTS (ONLY FOR THOSE APPLYING FOR THE PRIVILEGE)
If you are requesting procedural sedation privileges, we must have a completed exam with a passing score on file for you. Please review the documents below and submit your completed exam to the Medical Staff Office.
Procedural Sedation Policy
Procedural Sedation Study Guide
Procedural Sedation Exam
Please be reminded that prior to seeing patients you must visit the Medical Staff Office/Human Resources (take front lobby elevator to the basement level) in order to acquire a SVH Photo ID badge. You will need to bring your State or Federal photo ID or a valid ID badge from another hospital for verification of your identity.