Get Oh Ntmc Verification Form For Clinical Practice Hours 2017

Filling out the OH NTMC Verification Form for Clinical Practice Hours is an essential step for neonatal caregivers seeking certification. This guide will assist you with detailed instructions on how to complete the form accurately online.

Follow the steps to successfully complete your verification form

1. Click ‘Get Form’ button to access the OH NTMC Verification Form For Clinical Practice Hours and open it in the editor.
2. Begin by filling out the NICU or SCN Employment History section. Provide the hospital name, hospital address, nursery level (II, III, IV), and the years of NICU employment (for example, 1998 – 2003). Specify your employment status as either Full Time (FT) or Part Time (PT).
3. In the verification statement, print your name clearly. Indicate your professional role by checking the appropriate box: Occupational Therapist, Physical Therapist, Speech Language Pathologist, or Registered Nurse. Then, sign and date the form to confirm that you have practiced a minimum of 1000 hours in the NICU or SCN.
4. Have your supervisor complete their section. They need to print their name, current title, sign the form, and provide their email address and the date. This verifies your experience and ensures they are aware of your application.
5. After completing all sections, save your changes. You can then download the completed form, print it for physical submission, or share it via email to info@infantdriven.com, or via fax to 1-937-667-7426.

Start filling out your verification form online today to take the next step in your neonatal certification process.