Allied Health Professionals

Please Read First, then download and complete the following forms.

AHP Application
Core Privileges: PA, NP, CRNA, Optometrist
Authorization and Release Form
Pre-Employment Physical Screening
Peer Evaluation Form (need 3)
>State Board of Medical Examiners clearance (for PAs)
Self-Directed Orientation

Questions or Problems
For any questions or problems with this application process, please call our Human Resources department. Our Employment Coordinator, Valencia Duhart, will be handling your application. You can reach her by the following methods:

Phone: 912-545-3663
FAX: 912-545-3768
Email: Valencia.Duhart@libertyregional.org




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