Get Oklahoma Verification Of Clinical Clerkship Form

Filling out the Oklahoma Verification Of Clinical Clerkship Form is an essential step for medical students completing clerkships in the United States. This guide provides detailed, step-by-step instructions to help you complete the form efficiently and accurately online.

Follow the steps to complete your form online

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the student's name in the designated field provided on the form. Ensure that you enter the full name as it appears on official documents.
3. Input the U.S. social security number in the appropriate section. Double-check for accuracy, as this number is crucial for identification purposes.
4. Enter the student's date of birth in the specified format. This should follow the MM/DD/YYYY format to ensure clarity.
5. Provide the name of the medical school affiliated with the student in the following section. This should be the official name of the institution.
6. In the next field, indicate the name of the facility where the clerkship was completed. Make sure that the facility's name aligns with any official records.
7. Fill in the address of the facility accurately, ensuring that all components (street address, city, state, zip code) are included.
8. State the duration of the clerkship by entering the starting date in the 'from' section and the ending date in the 'through' section. Use the correct format of Month, Day, Year.
9. Specify the clinical area associated with the clerkship. This may include areas such as internal medicine, pediatrics, etc.
10. Indicate the specialty for which the facility has ACGME accreditation. This should match the specialty relevant to the clerkship.
11. The facility program director or instructor must sign and print their name in the designated areas. A valid signature is necessary for verification.
12. If the institution does not have an official seal, ensure the signature of the facility program director or instructor is notarized.
13. After completing all fields accurately, you can save changes, download, or print the form for submission.

Complete your Oklahoma Verification Of Clinical Clerkship Form online today to ensure a smooth verification process.