Get 2165

The 2165 form, known as the Certificate of Postgraduate Training, is a crucial document for medical professionals seeking licensure in Wisconsin. This guide will assist you in accurately completing the form online, ensuring that all required information is provided clearly and effectively.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the physician's name in the designated field at the top of the form. Ensure that you use the correct spelling and format.
3. Next, provide the hospital name where the physician completed their training. It is important to ensure the name matches the registered institution.
4. Fill in the hospital address, including the street, city, state, and postal code. Accuracy is vital in this section to ensure proper identification.
5. Input the hospital telephone number. This contact information is essential for verification purposes.
6. In section one, check the appropriate boxes to indicate the type and level of training the physician participated in at the facility. Include the starting and ending dates and specify whether credit was given for the training.
7. Respond to the questions in sections two through fourteen by selecting 'Yes' or 'No' as applicable. If required, attach a separate sheet providing further explanations.
8. At the bottom of the form, the program director must print their name, provide a signature, and date the form to validate the information.
9. If the hospital has a seal, affix it in the designated area. If not, prepare a letter on hospital stationery attesting to the lack of a seal.
10. Once the form is completed, save your changes and ensure all sections are filled out correctly. You can then download, print, or share the completed form as required.

Complete your forms online quickly and efficiently today!