Get Medical Registrants Application Form - Department Of Health - Doh Dc

Completing the Medical Registrants Application Form is an essential step for medical training registrants in the District of Columbia. This guide will provide you with clear, step-by-step instructions on how to accurately fill out this form online, ensuring you understand each component and requirement.

Follow the steps to successfully complete your application form.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. In Section 1, indicate the type of registration. Select 'Medical Training Registrant' if your rotation is 90 days or less. Remember, this application is not a license.
3. Complete Section 2 with your personal information. Provide your legal name, date of birth, and social security number. Ensure you do not use initials unless they are part of your name. Select your gender, and remember to attach a copy of your driver’s license or government-issued identification.
4. Designate your race and ethnicity by selecting from the provided options. If your race or ethnicity is not listed, you may specify it in the 'Other' field.
5. Fill in the name of the medical school you attended, the country, and your graduation date. Include your current residency training program institution and state, and indicate your postgraduate training year.
6. In Section 3, select the hospital where you will be rotating in Washington, D.C. If you are rotating through multiple hospitals, use a separate form for each rotation. Indicate the dates of your rotation.
7. In Section 4, read and understand the affidavit. Affix your signature, print your name, and date your signing. This section attests that the information provided is accurate to the best of your knowledge.
8. Finally, print and mail the original registrant form to the rotating hospital program for review. Ensure you retain a copy for your records.
9. In Section 5, leave this section for verification by the designated individual from the rotating hospital. They will complete it after reviewing your application.

Complete your application form online to ensure a smooth registration process!