The pre-applications below include criteria for membership and/or privileges. Completed pre-applications should be returned to Medical Staff Services. Once it is determined that an applicant meets the minimum qualifications, a full application & privilege delineation form(s) may be extended.
Physician Pre-Application (MD, DO, DDS, DPM only): TCH_Med Staff PreApp_2010.pdf
Allied Health Pre-Application (ARNPs/PAs only): TCH_AHP PreApp_2010.pdf
Please return your completed pre-application & supporting documents to:
Louisa M. Beckstrand, CPMSM
Medical Staff Services
Toppenish Community Hospital
502 W. 4th Avenue
Toppenish, WA 98948
For updated information on the application process please contact: louisa.beckstrand@hma.com
Phone: (509) 865-1520
Fax: (509) 865-1519
Washington State - Licensing:
Physician (MD) and physician assistant forms: http://www.doh.wa.gov/hsqa/MQAC/forms.htm
Physician (DO): http://www.doh.wa.gov/hsqa/Professions/Osteopath/forms.htm
Dentists: http://www.doh.wa.gov/hsqa/Professions/Dental/default.htm
Podiatry: http://www.doh.wa.gov/hsqa/Professions/Podiatry/default.htm
Drug Enforcement Agency Registration:
Application: http://www.deadiversion.usdoj.gov/drugreg/reg_apps/onlineforms.htm