Attachment J.5 Clinical East Credential File Format.pdf
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- Solicitation number
- PSCFOH-ClinicalEastStaffing-Solicitation75P00125R00012-R
About this file
Attachment J.5 is a detailed credential file format specification for medical professionals seeking to work with Federal Occupational Health (FOH), specifically outlining required documentation for physicians, nurse practitioners, and physician assistants. The credential file is systematically organized into six sections that comprehensively cover professional qualifications, certifications, background checks, and health documentation.
Each professional category (physicians, nurse practitioners, and physician assistants) must submit a structured set of documents across sections including: attestation of completion, professional licensing and certification verification, identity documentation, insurance certificates, performance evaluations, orientation materials, continuing education records, and health-related documentation such as annual TB tests, flu vaccine records, and Hepatitis B documentation. Key requirements include primary source verification of professional credentials, current certifications, security clearance/background checks performed within 3 months of initial application, Basic Life Support certification, and three peer reference forms. The document is part of the Federal Occupational Health Clinical East Staffing Solicitation, which is a total set-aside for 8(a) small business concerns under the Department of Health and Human Services.
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Attachment J.5 – Credential File Format
Physicians:
Section 1 Attestation of Completion (Completed by Vendor) NPDB Authorization Form FOH Privileges, Recommendation and Dispensation with signatures FOH Privileging Letter
Section 2 Application for Appointment of Medical Staff with Privileges Request Form Proof of I-9 Completion/Identity Verification Certificate of Malpractice Insurance or Errors and Omissions Insurance Insurance Claims History
Section 3 Professional License – State or U.S. Territories/Commonwealth (current and past, active and inactive), primary source verified Medical School: primary source verified Educational Commission for Foreign Medical Graduates Certification (ECFMG), if applicable Internship: primary source verified Residency: primary source verified Fellowship: primary source verified, if applicable Preceptorship: primary source verified, if applicable Relevant Specialty: primary source verified, if applicable Board Certifications: primary source verified Security Clearance/Background Check performed within 3 months of initial application Office of Inspector General Sanction Report Basic Life Support (BLS) Certification from American Heart Association, Red Cross or American Health and Safety Institute accredited course (must contain hands-on component)
Section 4 Performance Evaluation (for the past 3 years)
Section 5 Job Specific Position Description, signed Initial Orientation Checklist Site Specific Orientation Documentation (signed) Curriculum Vitae or Résumé, current Continuing Professional Education (all other) FOH Peer Reference Form(s) (3 completed forms) Letters of Appreciation/Commendation and Awards Documentation of Personnel Actions
Section 6
Annual Tuberculosis (TB) Test Documentation (with reported results) and/or Annual Questionnaire at renewal (for clinical providers) Hepatitis B Documentation (vaccine, titer, or waiver) (for clinical providers) Flu Vaccine documentation, annual (for clinical providers)
Nurse Practitioners (NPs):
Section 1 Attestation of Completion (Completed by Vendor) NPDB Authorization Form FOH Privileges, Recommendation and Dispensation with signatures FOH Privileging Letter
Section 2 Application for Appointment of Medical Staff with Privileges Request Form Proof of I-9 Completion/Identity Verification Certificate of Malpractice Insurance or Errors and Omissions Insurance Insurance Claims History
Section 3 American Academy of Nurse Practitioners’ Current Certification: primary source verified Professional Licenses RN and NP (current and past, active and inactive): primary source verified Nurse Practitioner Program completion: primary source verified Internship: primary source verified, if applicable Security Clearance/Background Check performed within 3 months of initial application Office of Inspector General Sanction Report Basic Life Support (BLS) Certification from American Heart Association, Red Cross or National Safety Council accredited course (must contain hands-on component)
Section 4 Performance Evaluation (for the past 3 years)
Section 5 Curriculum Vitae or Résumé, current Initial Orientation Checklist Site Specific Orientation Documentation, signed Job Specific Position Description, signed Continuing Professional Education (all other) FOH Peer Reference Form(s) (3 completed forms) Letters of Appreciation/Commendation and Awards Documentation of Personnel Actions
Section 6 Flu Vaccine documentation, annual (for clinical providers) Annual Tuberculosis (TB) Test Documentation (with reported results) and/or Annual Questionnaire at renewal (for clinical providers) Hepatitis B Documentation (vaccine, titer, or waiver) (for clinical providers)
Physician Assistants (PAs):
Section 1 Attestation of Completion (Completed by Vendor) NPDB Authorization Form FOH Privileges, Recommendation and Dispensation with signatures FOH Privileging Letter
Section 2 Application for Appointment of Medical Staff with Privileges Request Form Proof of I-9 Completion/Identity Verification Certificate of Malpractice Insurance or Errors and Omissions Insurance Insurance Claims History
Section 3 State Physician Assistant License/Certification (active and inactive): primary source verified Professional Certification (current and past, active and inactive): primary source verified Accredited Physician Assistant Program: primary source verified Internship: primary source verified Security Clearance/Background Check performed within 3 months of initial application Office of Inspector General Sanction Report Basic Life Support (BLS) Certification from American Heart Association, Red Cross, or National Safety Council accredited course (must contain hands-on component)
Section 4 Performance Evaluation (for the past 3 years)
Section 5 Curriculum Vitae or Résumé, current Job Specific Position Description, signed Initial Orientation Checklist Site Specific Orientation Documentation, signed Continuing Professional Education (all other) Peer Reference Form(s) (3 completed forms) Letters of Appreciation/Commendation and Awards Documentation of Personnel Actions
Section 6 Flu vaccine documentation, annual (for clinical providers) Annual Tuberculosis (TB) Test Documentation (with reported results) and/or Annual Questionnaire at renewal (for clinical providers) Hepatitis B Documentation (vaccine, titer, or waiver) (for clinical providers)
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