Annual Credentialing

ANNUAL CREDENTIALING & PRIVILEGING REVIEW

The purpose of this review is to ensure that:
• Patient safety is constantly and consistently prioritized by all Healthcare Practitioners
(HCPs).
• Admission and operating privileges are the prerogative of HCPs who:
1. Are registered for independent practice with the HPCSA and/or HPCNA.
2. In their professional capacity, act within the medical specialty in which they are trained and suitably experienced (with potential exceptions in the case of clinical
emergencies).
• Mediclinic is compliant with relevant healthcare regulations.

PERSONAL INFORMATION

First Name

Last Name

Discipline/Speciality

Sub-Speciality

HPCSA/HPCNA Number

Practice Number

Email Address

FACILITY

Primary Hospital

Second Hospital

Third Hospital

DECLARATION

I am appropriately registered at the Health Professions Council of South Africa / Health Professions Council of Namibia as an independent practitioner

NoYes

I have valid indemnity Cover/Insurance

NoYes

If Yes, kindly indicate indemnity organisation/insurer

If No, kindly give details on approach

I have valid Basic or Advanced Life Support certification

NoYes

Are you aware of any complaints lodged against you with the HPCSA / HPCNA and/or any current HPCSA / HPCNA investigations pending an outcome?

NoYes

By clicking here and continuing, I agree that I will inform Mediclinic immediately should the above information change.

Thank you for submitting your information. Mediclinic will only revert if there are any enquiries or concerns. Feel free to reach out to the Hospital Manager should you have any questions.