Get Kansas State Board Of Healing Arts Form
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How to fill out the Kansas State Board Of Healing Arts Form online
Completing the Kansas State Board of Healing Arts Form is a critical step towards obtaining licensure in medicine and surgery in Kansas. This guide provides clear instructions on how to correctly fill out the form online, ensuring that all required information is accurately submitted.
Follow the steps to successfully complete your application.
- Click 'Get Form' button to access the Kansas State Board of Healing Arts Form and open it for editing.
- Enter your Kansas License number, if applicable.
- Indicate your full legal name including any suffixes, and note if you have used other names.
- Provide your residence, mailing, and email addresses. Ensure that your residence address is not a Post Office Box, unless you are a qualified participant under the Safe At Home Act.
- Input your daytime phone number, including area code.
- Fill in your social security number or tax ID, along with your National Provider Identifier (NPI) if applicable.
- Indicate your U.S. citizenship status and provide additional documentation if you are not a citizen.
- Detail all professional activities since your Kansas license cancellation, including addresses and exact dates.
- List all states or jurisdictions where you have been licensed or certified in a health care profession, if applicable.
- Complete and sign the Certificate of Employment section to be filled out by the director of your practice facility.
- Respond to the attestation questions thoroughly, ensuring that any 'yes' answers are elaborated on a separate page as required.
- Attach a recent 2"x3" photograph of yourself.
- Provide proof of at least 100 continuing education credits within the designated time frame and ensure you sign and notarize the Oath.
- Submit proof of your professional liability insurance coverage.
- Enclose a payment of $200.00 for the application fee.
- Finally, save your changes and download, print, or share the completed application as needed.
Start your application process online today to ensure timely submission and processing of your Kansas State Board of Healing Arts Form.
The new hire report form for Kansas is a document that employers must complete when they hire new employees. This requirement helps the state track employment and prevent fraud in public assistance programs. By submitting this form, employers contribute to state efforts to maintain accurate family support records. You can find the Kansas State Board of Healing Arts Form if you need further assistance in navigating employment regulations.
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