IMPORTANT NOTICE: The below MN Uniform Credentialing Applications and supplemental forms for practitioners have been revised. Effective January 1, 2025, prior versions of these forms will no longer be accepted by many organizations due to changes in state statutes.

Updated MN Uniform Applications and Supplemental Forms:
MN Uniform Initial Credentialing Application 11.2024
MN Uniform Recredentialing Application 11.2024
Practitioner Race and Ethnicity (MUCA Supplemental Form A) 11.2024
Immune Status Information Form (MUCA Supplemental Form B) 11.2024
MN Uniform Practitioner Change Form & Site Location Addendum 11.2024

The new versions of the MN Uniform Applications have been activated in the MCC CredentialSmart system, effective December 28, 2024.

Prior Versions to be Retired December 31, 2024:
MN Uniform Initial Application 04.2022
MN Uniform Reappointment Application 04.2022
MN Uniform Practitioner Change Form Site Addendum Form 04.2022
Immune Status Form 10.2016

MN Uniform Facility Credentialing Application (no recent revisions):
MN Uniform Facility Credentialing Application 01.2020

To confirm the version of an application or other form to be submitted, please contact the applicable entity directly.