Get Addendum To Tx Standard Credentialing Application - Genesis ... - Genesisdocs

This guide provides clear and comprehensive instructions for users on how to accurately complete the Addendum To Tx Standard Credentialing Application - Genesis. Whether you are a seasoned professional or new to the credentialing process, this step-by-step approach will assist you in submitting your application with confidence.

Follow the steps to fill out your application online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your provider name in the provided field. Ensure that this matches the name you wish to be credentialed under.
3. In the next section, provide your current phone number. This will be used for any necessary communication regarding your application.
4. Input your highest attained degree in the designated field to verify your qualifications.
5. Enter your email address. Make sure this is an active email since important updates may be communicated via this channel.
6. Respond to the questions regarding your prescribing authority by selecting ‘YES’ or ‘NO’. Provide your prescription authorization number if applicable.
7. Address the inquiry regarding your plans to prescribe controlled substances. Select ‘YES’ or ‘NO’ and include any relevant information.
8. If you hold DEA and DPS permits, fill in the corresponding numbers and their expiration dates in the provided fields.
9. Confirm that you have signed and understood protocols or written authorizations with your supervising physician by selecting ‘YES’ or ‘NO’. Attach any required documentation.
10. Complete the supervising physician information section if applicable, providing all necessary details like name, license number, and contact information.
11. Finally, review all provided information for accuracy. Sign the document using your written signature, date it, and print your name clearly.
12. After completing the form, save your changes. You may then download, print, or share the document as necessary.

Get started today by filling out your application online for a streamlined and efficient process.