Get Oh Bwc Medco-13 2021-2025

The Application for Provider Enrollment and Certification (MEDCO-13) is a crucial document for providers seeking BWC certification in Ohio. This guide provides clear instructions on how to effectively fill out the form online, ensuring that users understand each component required for successful submission.

Follow the steps to complete the MEDCO-13 form with ease.

1. Press the ‘Get Form’ button to acquire the MEDCO-13 form and open it in your digital editor.
2. Begin by completing Section 1, where you will select your provider type. Ensure that you choose the option that best fits your practice. If your provider type is not listed, refer to the MEDCO-13A document for guidance.
3. In Section 2, provide your general information. You will need to enter your current BWC provider number (if known), your tax identification number, and your business legal name as recognized by the IRS. Additionally, provide contact information including telephone and email.
4. Proceed to Section 3, where you will detail individual provider information including specialty certifications and educational backgrounds. You must include your date of birth and relevant licenses.
5. Next, answer the questions in Section 4 honestly. If any answers are 'Yes,' you will need to provide a detailed explanation on a separate sheet as indicated.
6. Finally, complete Section 5 by agreeing to the application terms and conditions and providing your signature. Ensure that you include the date and full name as required.
7. Once all sections are filled out, you can save your changes, download the form to have a physical copy, or share it via email for submission.

Complete your OH BWC MEDCO-13 application online today to ensure your certification process begins smoothly.