Get Idacare

The Idacare online form is a vital document used by healthcare providers in Idaho to furnish necessary information for licensure or registration. Completing this form accurately is essential for maintaining compliance and ensuring proper licensing.

Follow the steps to fill out the Idacare form with ease.

1. Press the ‘Get Form’ button to access the Idacare online document and open it in your digital interface.
2. Fill in the licensee details, including license number, full name, mailing address, city, state, zip code, and date of birth in the specified format (m/d/yyyy).
3. Complete section A by providing your education details, including medical school attended, city, and graduation date, as well as details for internships, residencies, and fellowships.
4. In section B, list any specialty certifications recognized by the American Board of Medical Specialties, such as Family Practice or Psychiatry.
5. For section C, detail any special positions held at medical or professional schools and indicate responsibilities for graduate education within the last 10 years.
6. In section D, provide a comprehensive practice history for the past 10 years, including current practice location, type, and duration.
7. Section E requires you to identify your primary admitting hospital where you have active clinical privileges.
8. Answer the questions in section F regarding participation in Medicaid and Medicare, including any history of being barred from participation.
9. If applicable, indicate whether you provide translating services in section G.
10. In section H, disclose any criminal convictions for felonies or similar crimes within the past 10 years.
11. Section I prompts you to list any disciplinary actions taken against you by any board in the last 10 years.
12. Provide information in section J about any hospital privilege sanctions or similar disciplinary history.
13. Address your professional liability insurance status in section K.
14. If applicable, disclose any malpractice history in sections L and M.
15. In section N, declare your ownership interests in other health facilities or laboratory equipment.
16. Finalize the form by signing the declaration, ensuring accuracy and truthfulness of information provided.
17. Once completed, save the changes, and consider downloading, printing, or sharing the form as necessary.

Complete your Idacare online form today for a smooth and efficient licensing process.