Get Md And Advanced Practice Rn Renewal Application - Doa La

Filling out the MD And Advanced Practice RN Renewal Application - Doa La online is an essential step for healthcare providers seeking to renew their licensing. This guide provides clear, step-by-step instructions to help you accurately complete the application.

Follow the steps to successfully complete your application.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin with section 1: Provider details. Enter your complete name and mailing address. Fill in your license number and date of birth, then provide your street address, including line 1 and optionally line 2. Specify your professional specialty and provide the city, state, and zip code.
3. Next, provide your phone number and email address. If you are an advanced practice nurse, include the name of your supervising physician.
4. Move to section 2: Primary coverage. Ensure that you have the Certificate of Insurance or declarations page from your insurer as it is required. Fill in the insuring company's name, policy number, and effective dates for your insurance coverage.
5. Indicate whether the coverage is claims made or occurrence. Record the effective date, expiration date, and other necessary policy details such as primary premium and professional liability limits.
6. Address the question about your working hours. Indicate if you work less than 20 hours per week by selecting 'Yes' or 'No'. If applicable, complete the additional form PCF12.
7. If your coverage is for a corporation, ensure to provide a separate Certificate of Insurance and a corporation application (PCF9). Additionally, inform the PCF about any offsite entities requiring coverage.
8. Complete the required signatures. Remember that the signature field must be filled for the application to be valid.
9. After filling out all sections, make sure to save any changes made. You can download, print, or share the completed form as necessary.

Begin filling out your MD And Advanced Practice RN Renewal Application - Doa La online today for a smooth renewal process.