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University Neuropsychiatric Institute Application and Forms

Rules & Regulations

Bylaws Table of Contents

Bylaws

Applications:

Participating Provider Application

Mid-Level Provider Application

Privilege Forms:

Psychology Psychiatry Associate Physician

Non-Psychiatry Physician

Consulting & Associate Physician UNI HOME APRN

UNI HOME Non-Psychiatry APRN

UNI HOME LCSW UNI HOME Psychology
UNI HOME Psychiatry

UNI HOME Non-Psychiatry

UNI HOME Physician Assistant

Other Forms:

APRN Consultation and Referral Plan

PA Delegation of Services

PA Notification of Change



For further information please contact:
Jeff Carter
Credentialing Specialist
University Neuropsychiatric Institute
Jeff.carter@hsc.utah.edu
Phone (801)587-6024
Fax(801)585-1605