Medical Staff Voluntary Resignation Form

Professional Medical Staff Resignation Made Simple

When healthcare professionals need to transition away from a facility, whether for career advancement, relocation, or personal reasons, the resignation process requires careful documentation to protect both the provider and the institution. This Medical Staff Voluntary Resignation Form streamlines the entire process, ensuring all privileges are properly relinquished, ongoing patient cases are addressed, and pathways for future reapplication remain clear.

Designed for Healthcare Administration Teams

Healthcare facilities, hospitals, medical groups, and clinic administrators rely on standardized resignation processes to maintain credentiality files, manage privileges, and ensure continuity of patient care. This template captures essential information including:

• Formal resignation notice with effective dates and reason for departure
• Privilege relinquishment across all departments and specialties
• Ongoing case management to ensure proper patient care transitions
• Future reapplication preferences to maintain positive relationships
• Contact information updates for credentialing follow-up

Streamline Medical Staff Operations with Paperform

Paperform makes it easy to collect, organize, and act on resignation requests from medical staff members. The form's conditional logic adapts based on whether the provider has ongoing cases or wishes to maintain reapplication eligibility, ensuring you collect exactly the information needed for each situation.

Take it further with Stepper: Connect this form to your workflow automation with Stepper to automatically notify medical staff offices, update credentialing databases, trigger exit interviews, and create task lists for privilege termination and credential file updates. You can route different resignation types to appropriate department heads and ensure compliance documentation is completed on schedule.

Add eSignatures with Papersign: Use Papersign to convert submissions into formal resignation agreements requiring electronic signatures from both the resigning provider and medical staff leadership, creating a legally sound audit trail for your credentialing files.

Whether you manage a large hospital system or a specialty clinic, this template helps you maintain professional relationships with departing medical staff while ensuring regulatory compliance and continuity of care.