Request an Application From Blessing Hospital Medical Staff Services

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:
  • State of Illinois initial application
  • Privilege form(s)
  • Initial Credentialing Documents
  • Blessing Consent and Release
  • Pharmacy Signature Page
  • Medicare/Medicaid Attestation
    • Coverage arrangements form (MD/DO/DPM only)
    • Supervising agreement (Advanced Practice Providers only)

An application fee of $200 is required for all initial applications. This form allows the option of payment via credit card or check.

Contact Information for Initial Appointments Staff
Initials phone: (217) 223-8400 ext. 6677
Initials fax: (217) 223-0610
Initials email: MedicalStaffServices@blessinghealthsystem.org

Important information for all applicants:

  • All credentialed practitioners are expected to read and be aware of the information contained in the following link:
  • Initial privilege requests for moderate/conscious sedation require the completion of a conscious sedation test and current ACLS certification

Affiliation Verification Requests:

Blessing Hospital is pleased to provide you with an online verification service which allows outside organizations to quickly and easily generate an print an instant verification of affiliation for any practitioner (past or present) via the internet at http://www.mdquery.com/blessing.

The website represents current practitioner status information and is maintained by Blessing Hospital's Medical Staff Office. All information in the database is secure and cannot be altered by outside parties, therefore meeting the Joint Commission and NCQA standards. This internet service should be used forall affiliation verification requests. However, if you are prompted to contact the Medical Staff Services office, please fax your request to Medical Staff Services and a Medical Staff Coordinator at (217) 223-0610 and a staff member will complete your request as soon as possible. (Please allow at least one week for a response.)