Get Georgia Uniform Allied Healthcare Professional Credentialing Application Form

Filling out the Georgia uniform allied healthcare professional credentialing application form correctly is essential for a smooth application process. This comprehensive guide will provide you with clear and supportive step-by-step instructions to help you complete each section of the form online.

Follow the steps to successfully complete your application.

1. Click the ‘Get Form’ button to access the Georgia uniform allied healthcare professional credentialing application form and open it in your browser for editing.
2. Begin with Part One of the application, which includes identifying information. Fill in your full legal name, address, contact details, date of birth, social security number, and citizenship status. Be sure to provide truthful responses.
3. In the practice information section, detail your primary and secondary clinical practice settings. Include the name, address, type of practice setting, and contact numbers for each practice.
4. Move on to the certification section, indicating whether you are certified by any board in your profession, along with the relevant details about your certifications.
5. Complete the education, training, and professional experience section, making sure to list your academic qualifications and any professional training you have undertaken.
6. If applicable, provide details about other state healthcare licenses, registrations, and certificates, making sure to include all relevant information.
7. Fill in the professional practice and work history section, listing all relevant employment experiences in reverse chronological order, including any interruptions in practice.
8. List three professional references who can vouch for your qualifications and character. Ensure that at least one reference is from a licensed peer in your professional discipline.
9. Complete the professional liability insurance section, providing details about your current and any previous coverage, ensuring you follow the specified requirements.
10. Finally, review the application to ensure all information is complete, accurate, and that you have signed and dated where necessary. Save changes to your form, and from here, you can download, print, or share the completed application.

Complete your application online now to take the first step towards your credentialing process.