Get 2012 Oregon Practitioner Recredentialing Application - Pacificsource

Filling out the 2012 Oregon Practitioner Recredentialing Application is a key step in maintaining your professional credentials. This guide provides clear, step-by-step instructions on how to complete the application accurately and efficiently online.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the application and open it for editing.
2. Begin by providing your full legal name and contact details in the Practitioner Information section. Make sure to include any other names you have used, as well as your date of birth and Social Security Number.
3. In the Specialty Information section, detail your principal clinical specialty and indicate if you wish to be designated as a primary care practitioner. Check all applicable boxes regarding your professional activities.
4. Complete the Board Certification / Recertification section, listing all current and past certifications. Attach additional sheets if necessary.
5. In the Practice Information section, provide details about your primary and secondary practices, including addresses, contact numbers, and the names of office managers.
6. Detail your work history for the past three years, including military service. This should be listed chronologically, and if there are any gaps, explain them in the designated section.
7. Fill in the Peer References and Professional Liability Insurance sections with required information about references and coverage, respectively.
8. Answer the Attestation Questions truthfully. Each answer has significant importance, and any 'yes' responses should be detailed on a separate sheet.
9. Lastly, review the entire application for accuracy, sign and date where indicated, and ensure that you have included any required attachments.
10. Once complete, you can save changes, download, print, or share the application as required before submitting it to the appropriate health care organization.

Complete your recredentialing application online today for a smoother process.