Get Uniform Application - Avesis

Filling out the Uniform Application - Avesis online requires careful attention to detail and adherence to guidelines. This guide provides clear, step-by-step instructions to help you navigate each section of the form effectively.

Follow the steps to successfully complete the application.

1. Click 'Get Form' button to obtain the form and open it in your preferred editor.
2. Start by providing your demographic and personal data. Fill in your full name, date of birth, and Social Security number. Indicate your primary and secondary specialties and detail the population you treat.
3. Enter the name of your practice and provide its primary office address. Ensure to state if the facility is handicapped accessible and whether you are accepting new patients.
4. List any additional office addresses, including billing addresses if they differ from the primary office. Complete sections regarding contact numbers and office hours.
5. If applicable, provide information about other providers in your practice, and clarify if nurse practitioners or assistants are part of your team. Attach any necessary proof of employment or insurance.
6. Document your education and practice history, including details about medical school, internships, residencies, and work history.
7. Complete the professional information section by answering the yes/no questions honestly and attaching a supplemental form for any affirmative responses.
8. Make sure to sign and date the application. Check that all required attachments are included, such as copies of licenses and certificates.
9. Finalize your application by saving changes, and when ready, download, print, or share the completed form as necessary.

Begin your application process online today and ensure you have all necessary information ready for submission.