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Ask the expert: What language should I include in a credentialing application or reapplication release form?

Credentialing Resource Center Connection, March 20, 2008

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As long as your organization includes the necessary elements, as well as any state- or organization-specific requirements, any specific language you decide to use should suffice. Your legal council should always review and approve any substantive changes to any information contained in these documents.

Examples of key language you may want to incorporate in your release forms include:

• Applicant authorizes and releases from liability the organization, its employees/representatives, and affiliates when gathering, obtaining, and exchanging documents, records, and other information pertaining to his or her application.
• Applicant authorizes any third parties (including, but not limited to, individuals, agencies, medical groups, corporations, companies, employers, hospitals, health plans, licensing agencies, insurance companies, medical societies, etc.) to release information concerning his or her qualifications, credentials, clinical competence, quality insurance data, information pertaining to character, physical or mental health condition, behavior, ethics, claims history, disciplinary action, or any other matter reasonably having a bearing on his or her qualifications. Applicant releases above said entities from liability and holds harmless any entities or third parties for their acts performed in good faith without malice.

This week's answer is from HCPro's The Essential Guide to Medical Staff Reappointment: Tools to Create and Maintain an Ongoing, Criteria-Based Process, Second Edition, by Anne Roberts, CPMSM, CPCS.

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