Hospital Affiliation Verification Request
Letter and response form asking a hospital or other facility to confirm appointment dates, staff category, privileges, standing and adverse actions.
Download .docxGeneral template, not legal advice
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Hospital affiliation verification
How to verify hospital affiliations, NAMSS PASS and related sources, what accreditors say, and request templates. Everything here is summarized from the linked sources.
On this page: Hospital affiliations · Affiliation sources · Medical staff office directory · Request templates · Looking for schools or training? See Education.
Hospital affiliation verifications
Three ways to verify
- Ask the facility directly. Send a written request to the hospital's medical staff office (or credentialing office) with the practitioner's signed release. Some facilities answer through their own online verification portal instead. Use our affiliation request template.
- Use NAMSS PASS. It's NAMSS's national database of affiliation history reported by participating hospitals, surgery centers, health plans and groups. Where a facility has posted one, you can print a standardized "good standing" letter. If no letter exists, NAMSS PASS says to contact the facility.
- Use a credentials verification organization (CVO). A CVO can do the outreach for you. The Joint Commission (TJC) accepts verification through a CVO that meets its criteria. See URAC and NCQA CVO programs on the Accreditation page.
What to ask for
NAMSS's Industry Credentialing Standards (voluntary) recommend asking for:
- Start and end dates (NAMSS uses MM/YY)
- Staff category or status (for example active, courtesy or provisional)
- Whether the practitioner is or was in good standing. NAMSS bases "good standing" on the HCQIA definition of adverse action.
- At least the last 5 years of affiliations. For locum tenens or telemedicine practitioners, the 10 most recent.
- A written explanation of any gap over 30 days
Many organizations also ask (general practice, check your policy): the department, privileges held, and any adverse actions, restrictions, pending investigations, or resignations while under investigation. Our template includes these questions.
Turnaround and tips
- Turnaround varies by facility. We found no published standard. NAMSS describes direct requests to hospitals and medical staff offices as taking "days or weeks". NAMSS PASS results are available right away when the facility has contributed data.
- Include identifiers that help the facility find the record: full name and former names, NPI, specialty and approximate dates. Attach the signed release.
- Log each request and follow-up. Our Payer follow-up log works for this too.
- Keep the documentation TJC lists for primary source verification: the date, who verified it, what was verified and the result.
These tips are general practice suggestions, not requirements, except where a source is named.
Affiliation verification sources
NAMSS PASS, the NAMSS Industry Credentialing Standards, TJC's primary source verification FAQ, health system affiliation portals, facility directories and military records. Each card covers what the source verifies, who accepts it as a primary source (only where the source or an accreditor says so), what it costs, and the link.
Tip: If a facility isn’t in NAMSS PASS or a health system portal, look the facility up in our Medical Staff Office Directory below (or AHD.com or Medicare Care Compare), then call its medical staff office to confirm where to send a written request. Confirm any directory contact with the facility before sending a signed release.
Some links courtesy of Summit Healthcare’s Credentialing Resource Verifications page for MSPs.
Medical Staff Office Directory
Find a U.S. hospital and where to send an affiliation or privileges verification request. The hospital list (name, type, city, state, ZIP, main hospital phone and CMS Certification Number) is public data from CMS’s Hospital General Information dataset (last modified July 22, 2026, retrieved Oct 31, 2026). Medical staff office and verification contacts were confirmed only on the hospital’s or health system’s own website, and each confirmed row shows the page we checked. “Centralized” rows go to a system-wide verification portal. For HCA Healthcare, CommonSpirit Health and Sanford Health, we matched hospitals to the system using the AHRQ Compendium of U.S. Health Systems (2023) plus current CMS names and ownership. Systems buy and sell hospitals, so if the portal doesn’t list the facility, call the main line. Contacts change. Always confirm with the facility before sending a signed release.
Loading hospital list…
| Hospital | Type | City | State | ZIP | Main hospital phone | CCN | Medical staff office / verification |
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Know a medical staff office contact we don’t have, or see one that changed? Send it to us with a link to the hospital’s own page that shows it. Submit an update ✉ Opens your email app; nothing is stored on this site.
Affiliation, peer reference & work history templates
General templates, not legal advice. Adapt them to your policies and accreditor standards. Always include the practitioner's signed authorization and release.
Peer Reference Request
Letter and response form for a peer reference. It covers how long and in what role the reference has known the applicant ("Known applicant (From – To)", MM/YY), whether they worked directly together in the past 2 years, ratings on the six ACGME competencies, a recommendation on the privileges requested (attach a copy), conduct questions, signature and an office-use log.
Who uses it: Hospital MSP · Payor & CVO
General template, not legal advice
Work History / Employment Verification Request
Letter and response form asking a past employer or group to confirm dates (MM/YY), role, relationship type and standing. Includes an applicant work history summary and gap log based on NAMSS: history since training, at least the past 5 years, and a written explanation for gaps over 30 days.
Who uses it: Hospital MSP · Payor & CVO
General template, not legal advice