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New Provider Applicant

Please review all of the documents below.

Confidentiality and Security of Information Policy/Statement (pdf)

Conflict of Interest Policy/Disclosure Statement (pdf)

Medical Staff Bylaws, Rules, and Regulations 2023 (pdf)


Please fill out the form below to verify that you have reviewed all of the New Provider Applicant information above.

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Step 1 of 4

Policy Agreement*
Conflict of Interest Policy*
Please check an option and disclose relationships if applicable

Tomah Health