Loading
Form preview
  • US Legal Forms
  • Form Library
  • Social Forms
  • Louisiana Social Forms
  • La Standardized Credentialing Application 2008

Get La Standardized Credentialing Application 2008

_____________________________________ _______________________________________________________________________________ _______________________________________________________________________________ THIRD PRACTICE LOCATION INSTITUTION/GROUP/CLINIC NAME (If applicable) OFFICE MANAGER STREET ADDRESS CITY PHONE NUMBER FAX NUMBER TYPE OF PRACTICE: SOLO STATE ZIP CODE OFFICE E-MAIL MULTISPECIALTY GROUP TAX IDENTIFICATION NUMBER/ DATE TAX ID # EFFECTIVE - PROVIDER SINGLE SPECIALTY GROUP .

How it works

  1. Open form

    Open form follow the instructions

  2. Easily sign form

    Easily sign the form with your finger

  3. Share form

    Send filled & signed form or save

How to fill out the LA Standardized Credentialing Application online

The LA Standardized Credentialing Application is a crucial document for medical professionals seeking to establish their credentials. This guide will provide you with clear, step-by-step instructions on how to fill out the application accurately and effectively online.

Follow the steps to complete your application with ease.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor. This will allow you to start entering your information directly.
  2. Begin with the general information section. Fill out your last name, first name, middle name, suffix, degree, gender, and any other names you have been known by, including your ECFMG number and UPIN number. Ensure to provide your contact information, including your home address, phone number, and email address if applicable.
  3. Proceed to list your primary practice location. Include the institution or clinic name, office manager, and address. Indicate the type of practice as either solo, multispecialty group, single specialty group, or hospital-based.
  4. Complete the office hours section, specifying availability for each day of the week, and indicate if you practice full-time or part-time. Additionally, note any languages spoken at this location.
  5. If applicable, add information about your second, third, and fourth practice locations following the same format as the primary practice location. Attach additional sheets if you have more than four locations.
  6. Fill out the correspondence section to specify where you would like communication to be sent, including the phone number, fax number, and email if different from the practice location.
  7. Provide details regarding medical records requests and specialty type. Include any relevant board certifications and the dates of certification and recertification.
  8. List your work history chronologically and include any professional licenses, DEA registration, and CLIA certifications as required.
  9. Complete the references section by listing three peer references familiar with your professional work.
  10. Answer the general questions honestly and provide explanations for any affirmative responses as instructed.
  11. Finally, review all entered information for accuracy and completeness. You can save changes, download, print, or share the form as necessary before submitting.

Get started with your application and ensure your credentials are recognized by filing the LA Standardized Credentialing Application online.

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.

Related content

LOUISIANA STANDARDIZED CREDENTIALING ...
DIRECTIONS. Please type or print in black ink when completing this form. If you need more...
Learn more
Additional Services
A non-refundable application fee of $300 is required with submission of the application...
Learn more
provider-manual.pdf
credentialing application. If there is an affirmative response to the related disclosure...
Learn more

Related links form

MO 4-H Foundation Scholarships 2013 MO 5645 P.D. 2010 MO MO 780-1097 2007 MO MO 780-1560 2004

Questions & Answers

Get answers to your most pressing questions about US Legal Forms API.

Contact support

The three different types of credentials include certifications, licenses, and registrations. Certifications validate specific skills and knowledge in a particular area, while licenses are granted by governmental bodies to allow practice in a field. Registrations include records that verify a professional's standing with relevant organizations. Ensuring these credentials are up to date can be effortlessly managed through the LA Standardized Credentialing Application.

The credentialing process involves verifying the qualifications of healthcare providers to ensure they are capable of delivering quality care. This includes gathering and reviewing documentation such as education, training, and work history. The LA Standardized Credentialing Application streamlines this process, providing a cohesive platform that allows for easy tracking and management of information.

The basis of credentialing lies in establishing a professional's qualifications, competence, and legitimacy. It serves to protect patients and organizations by ensuring that practitioners possess the necessary education, training, and experience. By using the LA Standardized Credentialing Application, you can efficiently create a standardized approach that meets regulatory requirements.

A credentialing check is a comprehensive review of a healthcare provider's professional background. This includes examining their education, licenses, and any malpractice claims. Effective credentialing checks are essential for patient safety, and using the LA Standardized Credentialing Application can provide a structured framework to facilitate these important reviews.

PHO credentialing refers to the process specific to Physician-Hospital Organizations, where hospitals credential their physicians for participation in healthcare networks. This process ensures that all physicians affiliated with the hospital meet established qualifications. By adopting the LA Standardized Credentialing Application, PHOs can streamline their credentialing processes efficiently and effectively.

The three types of credentialing include primary source verification, re-credentialing, and privileging. Primary source verification checks the original documents, while re-credentialing involves periodic checks to ensure ongoing compliance. Privileging grants specific rights to practice within certain areas, and using the LA Standardized Credentialing Application can simplify these processes, making credentialing easier for all parties.

Red flags in credentialing may include inconsistencies in work history, gaps in employment, or disciplinary actions against a license. These issues can raise concerns about a provider's qualifications and overall reliability. Identifying these red flags early in the process can be easier when using the LA Standardized Credentialing Application, which promotes accuracy and thoroughness.

The credentialing process involves verifying the qualifications and background of healthcare professionals. It ensures that providers meet the necessary standards to deliver safe and effective care. This process is critical for maintaining high-quality services, especially when using the LA Standardized Credentialing Application, which simplifies many of these steps.

The timeframe for getting credentialed with United can vary based on several factors, such as the completeness of the application and the complexity of the verification process. Generally, it can take anywhere from 30 to 90 days to complete all necessary checks after submitting your application. By using the LA Standardized Credentialing Application, you can ensure that your submission is thorough and well-organized, potentially speeding up the approval process.

Credentialing applications are documents that healthcare providers fill out to validate their qualifications for practice within various healthcare organizations. These applications typically require detailed personal and professional information, which helps institutions maintain high standards for patient care. With the LA Standardized Credentialing Application, healthcare providers can efficiently compile this information with a user-friendly approach that saves time and reduces errors.

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
If you believe that this page should be taken down, please follow our DMCA take down processhere.

Industry-leading security and compliance

US Legal Forms protects your data by complying with industry-specific security standards.
  • In businnes since 1997
    25+ years providing professional legal documents.
  • Accredited business
    Guarantees that a business meets BBB accreditation standards in the US and Canada.
  • Secured by Braintree
    Validated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.
Get LA Standardized Credentialing Application
  • Adoption
  • Bankruptcy
  • Contractors
  • Divorce
  • Home Sales
  • Employment
  • Identity Theft
  • Incorporation
  • Landlord Tenant
  • Living Trust
  • Name Change
  • Personal Planning
  • Small Business
  • Wills & Estates
  • Packages A-Z
  • Affidavits
  • Bankruptcy
  • Bill of Sale
  • Corporate - LLC
  • Divorce
  • Employment
  • Identity Theft
  • Internet Technology
  • Landlord Tenant
  • Living Wills
  • Name Change
  • Power of Attorney
  • Real Estate
  • Small Estates
  • Wills
  • All Forms
  • Forms A-Z
  • Form Library
  • Legal Hub
  • About Us
  • Help Portal
  • Legal Resources
  • Blog
  • Affiliates
  • Contact Us
  • Delete My Account
  • Site Map
  • Industries
  • Forms in Spanish
  • Localized Forms
  • State-specific Forms
  • Forms Kit
  • Real Estate Handbook
  • All Guides
  • Notarize
  • Incorporation services
  • For Consumers
  • For Small Business
  • For Attorneys
  • USLegal
  • FormsPass
  • pdfFiller
  • signNow
  • altaFlow
  • DocHub
  • Instapage
Form Packages
  • Adoption
  • Bankruptcy
  • Contractors
  • Divorce
  • Home Sales
  • Employment
  • Identity Theft
  • Incorporation
  • Landlord Tenant
  • Living Trust
  • Name Change
  • Personal Planning
  • Small Business
  • Wills & Estates
  • Packages A-Z
Form Categories
  • Affidavits
  • Bankruptcy
  • Bill of Sale
  • Corporate - LLC
  • Divorce
  • Employment
  • Identity Theft
  • Internet Technology
  • Landlord Tenant
  • Living Wills
  • Name Change
  • Power of Attorney
  • Real Estate
  • Small Estates
  • Wills
  • All Forms
  • Forms A-Z
  • Form Library
Customer Service
  • Legal Hub
  • About Us
  • Help Portal
  • Legal Resources
  • Blog
  • Affiliates
  • Contact Us
  • Delete My Account
  • Site Map
  • Industries
  • Forms in Spanish
  • Localized Forms
  • State-specific Forms
  • Forms Kit
Legal Guides
  • Real Estate Handbook
  • All Guides
Prepared for you
  • Notarize
  • Incorporation services
Our Customers
  • For Consumers
  • For Small Business
  • For Attorneys
Our Sites
  • USLegal
  • FormsPass
  • pdfFiller
  • signNow
  • altaFlow
  • DocHub
  • Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
© Copyright 1999-2026 airSlate Legal Forms, Inc. 3720 Flowood Dr, Flowood, Mississippi 39232
  • Your Privacy Choices
  • Terms of Service
  • Privacy Notice
  • Content Takedown Policy
  • Bug Bounty Program
LA Standardized Credentialing Application
This form is available in several versions.
Select the version you need from the drop-down list below.
2012 LA Standardized Credentialing Application
Select form
  • 2012 LA Standardized Credentialing Application
  • 2008 LA Standardized Credentialing Application
Select form