Baylor College of Medicine
Credentialing Checklist
Pediatric House Staff
Step 1: Complete the following forms. Print and return by April 13, 2016 to the address below
Department of Pediatrics
Pediatric House Staff Education
One Baylor Plaza BCM 320
Houston, Texas 77030
A. _____ Baylor House Staff Application – Start date is June 24, 2016
References are the same as your ERAS application. Do not write see CV. Please write N/A for any items that do not pertain to you. You will not yet be board eligible, have a medical license, a faculty appointment or practice or other clinical experiences. Remember to sign and date
B. _____ Document to establish identity form attached – i.e., copy of driver’s license
C. _____ Self-Insurance Application for Baylor Malpractice –
You will not have a Texas Medical License. You will be issued an Institutional Training Permit Number from the Texas Medical Board. The number will be pending. Start date is June 24, 2016. Completion date will depend on what program you are in. Question 14 does not apply. Remember to sign and date.
D. _____ Worker’s Compensation Insurance Form – BCM ID number is pending for non-Baylor medical
Students.
BCM students will keep their same BCM ID number.
E. _____ BCM Waiver Form – Your department is Pediatrics. Remember to sign and date
Your employment address will be:
Department of Pediatrics
One Baylor Plaza BCM 320
Houston, Texas 77030
F. _____ One copy of your updated CV
Step 2 - Your medical school registrar will need to complete the Dean’s Verification of Pending Graduation. The form must have the school seal and an original signature. No stamped signatures. Your medical school will return this form to our office on your behalf.
Due April 13, 2016 - Dean’s Verification of Pending Graduation
Step 3 - Register for an NPI Number
You will need to register for an NPI number. You will register as a student.
The taxonomy code is: Student in an Organized Health Care Education/Training Program - 390200000X
The web site to register:
https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.instructions
Once you receive your NPI number please send a copy of your number to (Melodie Allison)
Step 4 – Apply for your certified background check and drug screen
Order your Certified Background Check and drug screen-form. You are responsible for the cost.
The package code is AY25.
You can complete at any Certified Background testing centers.
You do not have to complete the test in Houston.
Please e-mail complete confirmation report to parker@ bcm.edu (Melodie Allison)
Step 5 - Bring to Pediatric Orientation June 13 2016
A. Final Medical School Transcript:
2 copies Final Medical School Transcript – must state degree conferred
B. Medical School Diploma
1 certified or notarized copy of your Medical School Diploma for GME
1 Xerox copy (for House Staff Office)
If unable to obtain notarizations we have notaries in the house staff office. You can make your copies in our office if needed. Melodie Allison and Holly Hummel
If your diploma is oversized you can take it to Kinko’s to obtain reduced copies.
Your Diploma must be in English.
Very important Information:
Latin diplomas or any other language must be translated. If your diploma is not in English, you must also provide certified translations.
If for any reason your diploma will be delayed, you must have a letter from your registrar stating the delay and the anticipated date you will receive.
C. Intern Data Form
Happy to answer any questions. or 832-824-1173