Get California Participating Physician Application Fillable

Filling out the California Participating Physician Application is a crucial step in ensuring your participation in the healthcare system in California. This guide provides you with clear, step-by-step instructions on how to complete the form efficiently and accurately.

Follow the steps to complete the application form.

1. Press the ‘Get Form’ button to access the California Participating Physician Application Fillable. This action will allow you to open the form in an online editor.
2. Begin with Section A, where you will answer the confidential health history questions. Carefully consider whether you have any ongoing physical or mental impairments that affect your ability to perform essential functions as a practitioner. If you answer 'yes', provide details about any accommodations needed.
3. Indicate whether you are a certified Worker’s Compensation provider. If you select 'yes', ensure that you attach a copy of your certification to the application.
4. If applicable, note whether you are a reservist. Specify your branch of military service and include the anticipated date of separation from reserve duty.
5. Fill in your Medicaid or Medi-Cal number as required in the designated field.
6. After completing all sections, confirm the accuracy of the information provided. By signing and dating the form, you will affirm that the details submitted are true and correct to the best of your knowledge.
7. Once you have reviewed all information, take the necessary actions to save changes, and download, print, or share the completed form as required.

Start your application process now and ensure your participation by completing the document online!