Get Attestation Application Uwmc - Uw Medicine

The Attestation Application UWMC - UW Medicine is a vital document for applicants seeking credentialing within the UW Medical Center. This guide provides clear, step-by-step instructions to help users complete the application accurately and efficiently.

Follow the steps to complete your Attestation Application

1. Click ‘Get Form’ button to obtain the Attestation Application UWMC - UW Medicine and open it in your document editor.
2. Begin filling out your information. Input your full name, job title, and employer organization. Provide reliable contact information, including a phone number and email address for yourself and a backup contact. Ensure this information is accurate, as you will need to submit a copy of your file upon request within 24 hours.
3. Be prepared to submit necessary documents including HIPAA training confirmation, immunization records according to CDC guidelines, and a confidentiality form.
4. State if you are UW personnel or non-UW personnel, as this affects the photo ID procedure and background check requirements.
5. Detail your proposed role at UWMC by selecting options such as research, clinical practice, or other relevant roles. Provide necessary information regarding licensure, including license type and expiration date, if required for your proposed role.
6. Provide your manager's information and signature. Ensure your manager attests to your competency in the proposed role, including their printed name, signature, and contact information.
7. Sign the application yourself, confirming the accuracy of the information provided. Be aware that your file may be subject to audit, and documentation must be provided within 24 hours if requested.
8. Finalize your submission by emailing the signed Attestation Application as a PDF attachment to the University of Washington Medical Center, Patient Care Services Administration. Include any additional required background check forms as well. Note that paper submissions and incomplete forms will not be accepted.
9. Retain a copy of your completed application and all related documentation in your employee file. Keep these records updated, as they may be audited.

Complete your Attestation Application UWMC - UW Medicine online to ensure a smooth credentialing process.