Get Application For For Active Or Visiting Physician.doc

Filling out the application form for appointment to the medical staff is an essential step for healthcare practitioners. This guide provides clear, step-by-step instructions to help you complete the APPLICATION FOR FOR ACTIVE OR VISITING PHYSICIAN.doc online with ease.

Follow the steps to successfully complete your application form.

1. Click the ‘Get Form’ button to access the application form and open it in your editing platform.
2. Begin by entering your name in the specified sections: last name, first name, and middle name.
3. Provide your complete home address, including a telephone number and cell phone number for contact purposes.
4. Fill in your office or clinic address along with the associated telephone number.
5. Indicate your sex and civil status, as well as your date and place of birth.
6. Enter your Tax Identification Number and Professional Regulation Commission number, including the date of original issue.
7. Describe your specialty or field of practice clearly.
8. List the names and relationships of your dependents, if applicable.
9. Detail your educational background by listing the schools attended, degrees earned, and years of attendance.
10. Provide information regarding post-graduate training, including the name of the hospital or institution, and dates of residency or fellowship.
11. List any other hospital affiliations, starting with the most current, indicating your status and appointment details.
12. Include your memberships in professional or service societies, noting the position held, membership status, and date elected.
13. Document your medical or specialty board certificates.
14. If applicable, provide a list of published articles or papers.
15. Add professional references, ensuring to attach letters of recommendation, especially from VRP Medical Center.
16. Respond to the miscellaneous questions honestly, providing additional details on separate sheets if necessary.
17. Review your application for accuracy and completeness, then print, download, or save the completed form as needed.

Complete your application online today to ensure a smooth appointment process.