Get Form B - Rcp Reference Form.doc - Medicalboard Georgia

Filling out the Form B - RCP Reference Form is an important step in obtaining certification as a Respiratory Care Practitioner in Georgia. This guide provides clear, step-by-step instructions on how to properly fill out the form online to ensure a smooth submission process.

Follow the steps to complete the Form B - RCP Reference Form.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. In Section 1, the applicant should fill out their details, including their last name, first name, middle initial, maiden name (if applicable), mailing address, telephone number, and place of employment or college clinical. Ensure all fields are accurately filled out for proper identification.
3. In Section 2, the licensed physician or program director is responsible for evaluating the applicant. They must check the appropriate boxes indicating the applicant's dependability, quality of work, and professional responsibility using the provided scale (Excellent, Good, Poor, Not able to make judgment).
4. The physician should enter the date employment started, providing month, day, and year. They must assess whether the applicant can competently perform as a Respiratory Care Professional by marking 'Yes' or 'No'. If 'No', an explanation is required.
5. Next, the physician must indicate whether they would recommend certification based on the applicant’s abilities, including an explanation if 'No'. They should also indicate the type of employment (full-time or part-time) and approximate hours worked per week.
6. In the additional comments section, the physician may include any further thoughts on the applicant's qualifications. They must also fill out their current workplace details, including the name of the business, hospital, or school, and its city and state.
7. Finally, the physician needs to print their name, sign the document, include their license number, business telephone number, state of licensure, and the date of signing. Ensure all required fields are completed for a valid reference.
8. Once the form is fully completed, save changes to the document, and you may choose to download, print, or share the form directly.

Prepare and complete your documents online today for a streamlined application process.