Get Oregon Practitioner Credentialing Application Addendum Form
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How to use or fill out the Oregon Practitioner Credentialing Application Addendum Form online
Completing the Oregon Practitioner Credentialing Application Addendum Form online is a straightforward process that captures essential information about your professional practice. This guide provides step-by-step instructions to help you accurately fill out the form and submit it efficiently.
Follow the steps to complete your application addendum form online.
- Click ‘Get Form’ button to access the form and open it for editing.
- Begin by entering your identifying information in the designated fields, including your last name, first name, middle name, and medical group or IPA affiliations. Indicate whether you wish to be designated as a Primary Care Physician by selecting 'Yes' or 'No'.
- In the billing information section, provide the name and address of your billing company. Include the street address, city, state, and zip code. Also, fill in a contact person’s name and their telephone number, along with your federal tax ID number and fax number.
- For practice information, indicate if you are a Physician Assistant Supervisor by selecting 'Yes' or 'No'. If 'Yes', attach a copy of your supervisor license. Also, state if your practice is limited to certain ages, and if so, specify the ages.
- In the office hours section, clearly indicate the hours your office is open for each day of the week, including Monday through Sunday.
- List any foreign languages spoken fluently by you or an office staff member. Provide details in the specified sections for both physicians and staff.
- As a final step, answer the questions regarding ARC audit scores, specifying if you have ever had a score below 80% and whether a re-audit was performed. Ensure all statements are accurate.
- Once you have completed all sections, review your form for accuracy. You can then save changes, download, print, or share the form as needed.
Complete your Oregon Practitioner Credentialing Application Addendum Form online to ensure a smooth credentialing process.
The process of credentialing involves several key steps, including application submission, document collection, and verification of credentials. Utilizing the Oregon Practitioner Credentialing Application Addendum Form can streamline this process significantly. After submission, a review committee will assess your qualifications and make a decision based on established criteria. This systematic approach ensures both compliance and quality care in healthcare settings.
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