Get Odh Form 606 - State Of Oklahoma Web Site - Ok

Filling out the ODH Form 606 is essential for professionals seeking credentialing in the State of Oklahoma. This guide walks users through each section of the form to ensure all required information is accurately provided.

Follow the steps to successfully complete the ODH Form 606.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Start with Section 1: Personal Information. Fill in your name, professional degree, social security number, date of birth, and citizenship status as requested.
3. Move to Section 2: Directory Information. Complete your mailing address, office addresses, and contact details including phone numbers and email addresses.
4. Proceed to Section 3: Current Professional Practice. Indicate your primary and secondary specialties, whether you accept new patients, and your hospital admitting privileges.
5. In Section 4: Education, provide details about all professional schools attended, listing institution names, degrees awarded, and dates of attendance.
6. For Section 5: Training, list all internships, residencies, and fellowships completed, detailing the program type, institution name, and dates attended.
7. Continue to Section 6: Academic Appointments. List all academic positions held, specifying the institution, position, and duration.
8. In Section 7: Health Care Affiliations, detail your affiliations with hospitals or health systems, marking your current primary and secondary admitting facilities.
9. Section 8 requires a chronological list of all other professional work history including clinics or partnerships.
10. In Section 9: Professional Licenses, record all licenses and registrations along with their issuing states and expiration dates.
11. Complete Section 10: Certifications and Registrations by listing any certifications, including DEA and board certifications.
12. For Section 11: Office Information, provide details about your primary and secondary offices including services offered and under whose ownership they operate.
13. In Section 12: Copies of Required Documents, check off and identify any documents you are attaching to your application.
14. Review Section 13: Attestation. By signing, you affirm that all provided information is accurate.
15. Use Section 14 for any additional information or clarification you wish to include.
16. Once you have completed all sections, save your changes, and choose to download, print, or share the form as needed.

Submit your completed form online to ensure a smooth credentialing process.