Follow the steps to accurately complete your application.

1. Click the ‘Get Form’ button to access the NASI Per Diem Malpractice application form and open it in your preferred editing mode.
2. Begin filling out the personal information section. Provide your full name, address, and contact details, including phone number and email. Ensure that you enter your date of birth and social security number accurately.
3. In the education and licensure section, list your education history, including nursing and anesthesia schools. Ensure you complete the sections on certifications and licensing, including any relevant dates and numbers.
4. Indicate your proficiency with the types of cases you are comfortable handling, as well as the skills you are proficient with. This will help to demonstrate your qualifications.
5. Answer the questions regarding any illnesses, disability, or legal issues. If you answer 'yes' to any of these questions, be prepared to provide additional details on a separate sheet.
6. Gather and include all required supporting documents as listed in Section VI, including copies of your driver's license, social security card, current licensure, and any certifications.
7. Complete your statement of consent and release by signing and dating where indicated. This will authorize NASI to verify your background and qualifications.
8. Review your completed application thoroughly to ensure all information is accurate and complete. Make any necessary corrections.
9. Submit your completed application along with all required documents to the NASI Credentialing Team, following the final submission instructions.
10. After submission, keep an eye on your email or phone for any communications regarding your application status.

Begin completing your NASI Per Diem Malpractice form online today!