Get Instructions For Completing California Participating Physician Application

This guide provides comprehensive and user-friendly instructions on how to successfully complete the California participating physician application online, ensuring all required information is gathered accurately and thoroughly. By following these steps, users can avoid common errors and make the application process smoother.

Follow the steps to accurately complete your application.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In Section II, provide all requested identifying information including your last name, first name, and contact details. Ensure that all information is accurate and legible.
3. In Section III, practice information must be shared. Enter the practice name if applicable, and list the office manager or administrator along with their contact information.
4. Section VI requires you to detail your internship or postgraduate training. Specify the type in month/year format (mm/yy) and include relevant details.
5. For Section VIII, enter the name of your issuing board for board certification. Complete all related questions to provide a comprehensive response.
6. In Section X, include all information related to your medical licensure and registrations, ensuring to provide NPI and Medi-Cal numbers.
7. Moving to Section XV, chronologically list work history activities since completing postgraduate training. This should also include any gaps in history explained on a separate page.
8. Section XVI requires you to answer attestation questions. Carefully read each question and answer truthfully to avoid complications in your application.
9. At the end of the form, you can save changes, download the completed application, print it, or share the form as needed.

Complete your application online today to ensure your participation process is seamless.