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Mailing Address:  
Fairview Energy Park
Fairview System Credentialing Office
2344 Energy Park Dr Ste 127
St. Paul, MN 55108
 
General Office
Phone:
612-672-7700
Fax: 612-672-4244
Email: fsco@fairview.org
  

Request an Application from the Fairview System Credentialing Office


All Applicants:
To request an initial application, add a facility or request additional privileges Click here to complete the application request form. A link to your electronic application packet and privilege form(s) will be emailed directly to the email address you provide on the form. 


Initial Credentialing Packet includes:

  • MN Uniform Credentialing application
  • Privilege form(s)
  • Criminal Background Study Disclosure and Authorization Form
  • Fairview Authorization and Release
  • CME Attestation
  • Medicare/Medicaid Attestation
  • Immunization Documentation Form
    Complete the Immunization Documentation Form included in the packet and fax to the Employee Occupational Health Service number as listed on the form.  
  • Application Fee Payment Form
    Initial applications require a fee of $200.  This form allows the option of payment via credit card or check. 

*Application fee for FPA only applications is $150.00

 Contact Information for Initial Appointments Staff

 

Important information for all applicants: 
  • All credentialed practitioners are expected to read and be aware of the information contained in the following links:

Code of Professional Behavior
Notice of Accommodating Deaf or Hard of Hearing Patients

  • Practitioners who hold privileges at a Fairview facility are also responsible to read and be aware of the information contained in the Privileging Principles.

  • Proctoring of privileges may be requested if a practitioner does not meet the criteria, such as number of cases performed, as indicated on the privilege form. Proctoring requests must be approved in advance. Information on the process and forms are in the Proctoring Policy .

Initial privilege requests for moderate and/or deep sedation require the completion of a learning packet and test in the Sedation Learning Packet.

Required immunization information:
Immunization compliance is required for all practitioners prior to privileges being reviewed for approval at a Fairview facility. The immunization documentation form must be completed with Initial or Reappointment applications, and faxed to Employee Occupational Health Services (EOHS) as listed on the form.


For questions about immunizations, see the Immunization FAQs, or contact EOHS via email at  tlayon1@fairview.org
      

 

 
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