Care4 Credentialing Instructions

Please review information provided, complete all required forms below, and send in one email to [email protected]

  1. An explanation of the Research Credentialing process – includes a list of required documents and instructions for submitting documents
  2. A Credentialing FAQs Sheet – please refer to this sheet first if you have any questions.
  3. FORM-003 Request for Memorial Hermann Electronic Medical Records Access for Research 
  4. FORM-004 Full Memorial Hermann Research Credentialing Application
  5. FORM-005 MH Researcher HIPAA Form

Once this is received in its entirety, we will begin processing your credentialing packet and will contact you soon. If you need full credentialing, we will contact you to schedule an interview. For EMR only candidates: you will receive an email with your CIRI Approval letter and if applicable, your specific online service request number (granting access to EMR), and instructions to check on the status of your request.

Required documents:

  1. A complete list of studies (printed from iRIS)
  2. Printed iRIS outcome letter for each of the studies you will work on – showing IRB approval as study personnel. You MUST be added as PERSONNEL to the study in iRIS
  3. Description of study tasks for each study: including what you will be doing and where you will need to go in the hospital for each study and why.
  4. Copies of your Driver’s License and diplomas (please make sure your picture is viewable).
  5. Copy of CITI Training
  6. Copy of your resume with your current employment
  7. Completed Research credentialing form
  8. Signed HIPAA Agreement form
  9. Completed EMR Request Form if applicable.
  10. CV/Resume.

Contact:
Joann Ivey
Executive Assistant
Clinical Research
Memorial Hermann-TMC
6411 Fannin, R364
Houston, Texas 77030
P: 713-704-5647
F: 713-704-5124
[email protected]