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Louisiana Standardized Credentialing Application Form: What You Should Know

La Standardized Credentialing Application — form The Louisiana Standardized Credentialing Form, Form 1040C-W, the Louisiana Standardized Credentialing Form, Form 1040G, Form 1040H The Louisiana Standardized Credentialing Form, Form 1040R First we need the person that is applying for the medical credentialing to fill out the medical application for each medical specialty area he/she is interested in. (e.g. Cardiology, Pediatric, Neurology etc.) To fill in the application, you will need to take a few things along. Physician Application Form 1) Medical license (if more than 1 person applying for credentialing) 2) Medical Specialty area of interest (see above, “List of Specialties”) 3) Age (under 19 must be accompanied by parent or guardian) 4) Current address that will be provided to medical school. If outside Louisiana, please contact your school for address and phone number. This is the Credentialing Application form which can be filled out on the following electronic formats.  The form is free and is not available for review online. The forms must also be submitted via email and in a printed form with your application. It is not a requirement. You do not have to complete the entire medical credentialing process when you apply. The Credentialing Form will then show information on each person of interest and the number of years(less 1 for medical students) of education and training the applicant has. The Credentialing Form contains information on the applicant. It allows finding out important information about each person that it applies to. For example, the Credentialing Form will have the dates of birth and educational details on every one of your application forms. As an example, the Medical History Summary Credential List Credentialing form will show information on each applicant from each state. Each applicant will have a different credentialing group. If the applicant does not have a medical degree, we must provide a certified copy of the applicant's transcript, if his/her highest degree was a Bachelors or Master’s degree from an accredited institution.

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