Houston Methodist Neal Cancer Center - Membership Application

Membership Benefits

1) Listed as a Member, Houston Methodist Neal Cancer Center in the Houston Methodist Physician Referral database.

2) Featured as a Member, Houston Methodist Neal Cancer Center on Find A Doctor search results web page.

3) Listed as a Member, Houston Methodist Neal Cancer Center on the physician's web profile on the Houston Methodist website.

4) Invited to participate in Houston Methodist Neal Cancer Center focused marketing activities.

5) Access to Houston Methodist Neal Cancer Center marketing materials to use in accordance with the Houston Methodist Brand Guide.

Applicant Information

First Name *

Last Name *

M.I.

Street Address *

City *

State *

Zip *

Phone *

Email *

Houston Methodist Neal Cancer Center Membership Requirements - Must achieve all 5 of the following criteria

1) Are you a part of a department that provides hospital or lab-based based services supporting the Cancer Center?

Yes No

2) Appointment to the medical staff or Institute for Academic Medicine, with privileges to practice or conduct research, at a Houston Methodist facility.

Yes No

3) Demonstrate support of the mission, vision, goals and objectives of the Houston Methodist Neal Cancer Center.

Yes No

4) Participate in hospital based quality and performance improvement standards as applicable.

Yes No

5) Submit a signed "Membership Application" whereby the physician agrees to subscribe to and abide by the membership criteria and standards.

Yes No

Commitment to Clinical Excellence - Must achieve all 3 of the following criteria

1) Attend and/or participate in a regional or national oncology conference bi-annually.

Yes No

2) Adhere to nationally accepted treatment guidelines.

Yes No

3) Full participation with the Cancer Registry to include completion of staging, definitive treatment plan, and timely follow up.

Yes No

Commitment to Cancer Program - Must achieve 3 of the following 4 criteria

1) Hold a leadership position at a Houston Methodist facility or an affiliated academic institution including but not limited to: (i) Medical or surgical department leadership. (ii) Hospital department leadership. (iii) Hospital based cancer program leadership.

Yes No

2) Serve as a leader or member of a cancer program committee or council including but not limited to: (i) Cancer Committee (in accordance with American College of Surgeons, Commission on Cancer program accreditation standards). (ii) Cancer Conference (Tumor Board). (iii) Other committee and/or workgroup.

Yes No

3) Participate in cancer registry quality assurance review or national guideline adherence review.

Yes No

4) Submit cases for presentation at Cancer Conference (Tumor Board): (i) Community based practice - Five cases submitted annually. (ii) Medical Center based practice - Ten cases submitted annually.

Yes No

5) Participate in one community and/or patient outreach activity promoting the Houston Methodist Neal Cancer Center annually.

Yes No

Commitment to Research - Must achieve 1 of the following 2 criteria

1) Participate as an investigator or collaborator in at least one cancer related clinical or research based study per year.

Yes No

2) Cooperate with Houston Methodist Neal Cancer Center to extend available Houston Methodist sponsored clinical trial information to eligible patients.

Yes No

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Disclaimer

To the best of my knowledge, the information I have provided in this membership application is accurate. I authorize the release of information relevent for my membership in the Houston Methodist Neal Cancer Center. I agree to hold the Houston Methodist Neal Cancer Center, its members, officers and representatives free from any damage or complaint by reason of any action they may take in connection with this application.

Applicants are reviewed and approved by the Houston Methodist Neal Cancer Center Membership Committee. Regular meetings of the Membership Committee occur quarterly.

I have read the "Physician Membership Criteria and Standards" and if approved for membership, I agree to subscribe to and abide by the guidelines. I understand that, as part of Cancer Center Membership Review and Approval Process, I will be asked to submit supporting documentation once every two years to sustain membership.

Questions about the application process should be addressed to Chris Than at cthan@houstonmethodist.org