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. Completion of this participation agreement is required.

I have medical staff privileges at a Saint Luke's hospital and I am in good standing.
I am committed to evidence-based medicine and utilizing SLC Physician Order Sets, when appropriate for my patients.
I will support and participate in clinical data review when appropriate.
I will maintain proficiency in the Saint Luke's clinical information system (EPIC).
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.

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.

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