NTC Surgeon's Office

Credentials Information

Below are the documents we need for you to complete in order to provide patient care at WACH and NTC, Fort Irwin. Please complete and return to me by fax or email as soon as possible. On the DA Fm 5440-18, use codes to select the privileges that you are requesting and line through and initial those that you are not requesting. Do not leave any privileges blank. Upon completion, we will have these form approved here. If you have any questions feel free to call me.

Credentials Coordinator
Weed Army Community Hospital
Work: (760)380-5388
Fax: (760)380-6293

• DA 5440A, Approval of Clinical Privileges
• AR 40-68, Clinical Quality Management
• DA 5754, Malpractice
• Provider request
• The Credentialing Process
• PEER RECOMMENDATION
• Statement of applicant
• Physician assistant