Provider Forms

Provider Forms/

Working with Medestar

Whether you are a new provider working with Medestar, or a returning contractor, this page will help you complete the necessary forms. For new providers, you have two options for getting started: you can complete your forms completely online or download them and submit to us via email. Both options are explained below. For existing Medestar contractors, the forms for timesheets and expenses are listed below for download.

Use the interactive video on the left to help you through the process. If you have any questions along the way, you may call us at (877) 868-5350 or reach our Operations Department Manager, Lisa Burrow, at lisa.burrow@medestar.com or fax us at 214-276-1954.

Video Instructions

New Physicians, Nurse Practitioners or Physician Assistants 

If you are a new locums provider going to work for Medestar, there are certain forms we need in order to process your application and credentialing. We’ve made it easy by allowing you to complete these documents online. You can even sign documents from your mobile or tablet device! Use the forms in this section if you are a physician, nurse practitioner (NP), or physician assistant (PA).

Complete Forms Online 

There are six forms that you need to complete, sign and submit as a new physician, NP or PA provider:

Download Forms

Having trouble using the online form? You can also download and complete required forms below or give us a call for further assistance 877-868-5350:

Physician, NP, PA Application Packet

Medestar PSA

 TB Questionnaire

Malpractice Claim Form

New Allied Providers

If you are a new locums provider going to work for Medestar, there are certain forms we need in order to process your application and credentialing. We’ve made it easy by allowing you to complete these documents online. You can even sign documents from your mobile or tablet device! Use the forms in this section if you are a registered nurse (RN), therapist, or other allied medical provider.

Complete Forms Online 

There are three forms that you need to complete, sign and submit as a new allied provider:

Download Forms

Having trouble using the online form? You can also download and complete required forms below or give us a call for further assistance 877-868-5350:

Allied Employment Application

W-9 Form

 TB Questionnaire

Existing Providers and References

If you are already working for Medestar, you can download and complete timesheets and expense forms below. This is also where you can complete a reference form online, if a Medestar physician has listed you as a reference.

Timesheets and Expenses 

Download and complete your timesheet and expense forms below:

Direct Deposit Form

Medestar Weekly Timesheet (PDF)

Medestar Weekly Timesheet (Online)

Tips for Timesheet

Reimbursement Policy & Form

References

When a provider goes to work for Medestar, we will ask for three professional references. If you have been listed as a reference for another provider, use the form below to submit your feedback:

Physician Reference Form

Reappointment Applications

If you have previously worked with Medestar, this is paperwork we need to update your profile every 2 years.

Reappointment Application

Release and Authorization Form

TB Questionnaire

If you are having trouble using the online forms, you can download a PDF of the packet to complete manually by clicking here.