Get The Maine Uniform Application For Reappointment - Meamss - Meamss

Completing The Maine Uniform Application for Reappointment online can seem daunting, but with careful attention to each section, you can ensure your application is filled out accurately and efficiently. This guide will provide clear, step-by-step instructions to help you complete the application with confidence.

Follow the steps to complete your application with ease.

1. Click ‘Get Form’ button to obtain the form and open it in your browser.
2. Begin by entering your personal information in Section I. Fill in your last name, first name, middle name, suffix (if applicable), and professional title/degree. Ensure that you include any other surnames you have used along with your social security number and date of birth.
3. In Section II, provide your local practice information. Enter the name of your primary office or group along with your office address, phone number, fax number, and email. Be sure to also list the name and contact details of your office manager.
4. Proceed to Section III to list your educational background. Enter any graduate degree programs, formal residencies, or fellowships completed since your last application, including the institution, director, and dates attended.
5. In Section IV, indicate your specialty and board certifications. Fill out the primary and secondary specialty designations and input details regarding board certification, including certification numbers and expiration dates.
6. Continue to Section V and chronologically list all current and previous hospital affiliations. Provide the institution name, address, phone number, position, department, and dates at the institution.
7. In Section VI, document all current and/or active licenses for the past five years. Include the state, license type, number, issuance date, expiration date, and status.
8. Section VII requires you to list all insurance carriers that provided professional liability coverage in the past five years, along with relevant details like policy number and coverage amounts.
9. If applicable, complete Section VIII by answering the required questions regarding privileges, legal issues, and health. Provide explanations for any affirmative responses on a separate sheet if necessary.
10. Finally, review your application for accuracy and completeness. Ensure that you sign and date the application where required, and make copies of your submission for your records. You can then save, download, print, or share your completed application as necessary.

Start completing The Maine Uniform Application for Reappointment online today for a smooth reappointment process.