Saint Luke's Care Membership Application

You are invited to join Saint Luke’s Care (SLC), a physician-led organization placing clinicians in the “driver’s seat” to impact care delivery at Saint Luke’s Health System (SLHS). Completion of this participation agreement is required.

I have medical staff privileges at one of the Saint Luke's Health System hospitals in good standing.
I am committed to evidence-based medicine and to utilizing SLC Physician Order Sets, when appropriate for my patients.
I will support and participate in clinical data collection and review.
I will agree to participate in Saint Luke’s Care sponsored CME programs.
I will maintain my proficiency in the SLHS clinical information system.
I will maintain an active email address for my SLC communications.

SLC member email will be kept confidential and used solely for important SLC/SLHS purposes.

Please note: Participation in Saint Luke’s Care is at the discretion of Saint Luke’s Care Board of Directors.

For more information about Saint Luke’s Care or this agreement, please contact us at saintlukescare@saint-lukes.org.

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First Name

Last Name

Specialty

Medical Group

Provider's Email

Phone

Address

Address 2

City

State

Zip/Postal Code

Office Manager's Name

Office Manager's Email Address

Saint Luke's Health System Affiliation(s)

Affiliation status

Signature

I agree that this serves as an electronic version of my signature and that all of the information provided is accurate.