Medical Staff Application Request

Los Alamitos Medical Center 

Thank you for your inquiry dated indicating your interest in applying for medical staff appointment and clinical privileges at Los Alamitos Medical Center.

The following are threshold eligibility criteria for appointment to the Medical Staff. Please read through this page  in it's entirety, and download the application at the bottom of this page. 

  1. A current, active professional license to practice in California, which is without restriction or limitation and no record in any state of licensure revocation, termination, suspension, probation, restriction, or limitation within past 10 years. Exemption is permissible for administrative reasons not related to crimes or professional competence or conduct.
  2. Current, unrestricted federal DEA registration with a California address and controlled substance license (if applicable).
  3. Satisfactory completion of, or current enrollment in, an accredited postgraduate residency training program in the specialty in which you are seeking clinical privileges. (Current Board Certification suffices as verification of completed residency.)
  4. Board certification by the appropriate specialty Board (e.g., for physicians ABMS and/or AOA). If the time period defined by the certifying board to achieve board certification has lapsed, then the practitioner must hold board certification. If the time period has not lapsed, the practitioner is eligible for application consistent with board certification requirements in the medical staff bylaws.
  5. Malpractice insurance coverage with a qualified carrier in the following form and amounts as defined by the medical staff bylaws: $1/3 Million and which covers all practice areas and anticipated privileges.
  6. Practitioner is not currently excluded, suspended, debarred, or otherwise ineligible to participate in Federal health care programs.
  7. No felony conviction or withhold of felony adjudication (includes a no contest plea or plea of guilt) and no pending felony charges. Not time limited.
  8. No pending charges and no convictions within past seven years, or withhold of adjudication for, plea of guilty or no contest, deferred prosecution or pre-trial intervention arrangement to a misdemeanor unless wholly unrelated to (a) the practice of your profession; (b) other healthcare matters; (c) third-party reimbursement; (d) violence; or (e) the use, prescription distribution, or furnishing of DEA scheduled drugs (Schedules I through V).
  9. Within past 10 years, medical staff membership and clinical privileges have been granted and maintained in good standing without adverse action of any kind, whether voluntary or involuntary, including but not limited to (10):
  10. * No record of denial, revocation, termination, suspension not related to administrative issues, reduction, loss, condition, restriction, limitation, involuntary resignation or relinquishment, voluntary resignation, relinquishment, or leave of absence after notice of investigation or discipline regarding appointment, membership, or clinical privileges in the same or similar specialty at any other hospital or healthcare facility or entity. (This restriction does not apply to adverse actions for administrative reasons. Reinstatement of unrestricted privileges or appointment within past ten years does not negate these criteria.) 

*Occurrences greater than 10 years past require practitioner to submit written explanatory summary and authorization for hospital to obtain further information from involved entities in addition to a completed application for appointment. 

Please be advised that the hospital has entered into exclusive arrangements for the following services and is not accepting applications in these specialties unless the exclusive provider has notified the Medical Staff that the applicant is affiliated with the exclusive provider: Anesthesia, Pathology, Emergency Medicine, Radiology and Radiation Oncology. 

Please download and complete the Request for Application documents and Background Check in their entirety and return them with all required supporting documentation no later than (30 days). A request received after this date will be returned for update. Please mail, fax or email your documents to:

Los Alamitos Medical Center
Medical Staff Services
3751 Katella Ave.
Los Alamitos, CA 90720
(562) 799-3160
Fax (562) 799-3133 

Upon receipt of the complete and accurate Request for Application, a determination will be made as to whether an Application for Medical Staff Appointment and Clinical Privileges may be extended to you. You will be notified of that determination, and if eligible, you will receive an application form as well as other specific information required for appointment and clinical privileges. 

Thank you for your interest in Los Alamitos Medical Center. If I can be of any further assistance, please contact me at (562) 799-3160 or email 


Cathy Novakovich

Director, Medical Staff Services