REVIEWED, AMENDED & APPROVED BY THE ADVISORY COMMITTEE ON PHYSICIAN CREDENTIALING INFORMATION (ACPCI) 5/1/12 OREGON PRACTITIONER CREDENTIALING APPLICATION Prior to completing this credentialing application, please read and observe the following: I. INSTRUCTIONS This form should be typed (using a different font than the form) or legibly printed in black or blue ink. If more space is needed than provided on original, attach additional sheets and reference the question being answered. .
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How to use or fill out the OR Oregon Practitioner Recredentialing App online
This guide provides a clear, user-friendly approach to completing the OR Oregon Practitioner Recredentialing App online. By following the outlined steps, users can ensure that their application is completed accurately and efficiently.
Follow the steps to fill out the OR Oregon Practitioner Recredentialing App online:
- Click the ‘Get Form’ button to obtain the form and open it in the editor.
- Begin entering your details in the Practitioner Information section, including the full legal name, any suffixes, and alternate names if applicable.
- Fill in your home address, contact numbers, and email address, ensuring the information is accurate.
- Complete the Specialty Information and indicate your primary clinical specialty and any additional specialties.
- If applicable, list your board certifications and attach any relevant supporting documentation.
- Provide your practice information, including the names and addresses of your primary and secondary practice locations.
- Fill in the Practice Call Coverage section with names and specialties of practitioners covering for you.
- Document your professional and educational history in the specified sections, clearly indicating the name, date, and location of institutions.
- Complete the professional liability insurance details and ensure to include your current carrier, policy number, and effective dates.
- Review the Attestation Questions thoroughly, answering each question truthfully, and make sure to sign and date the application.
- Finally, save your completed application. You will have options to download, print, or share the form as required.
Get started and complete your OR Oregon Practitioner Recredentialing App online today!
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