Get De Verification Of Experience And Competency 2017-2025

This guide provides clear instructions on how to complete the DE Verification Of Experience And Competency form online. Whether you are an Advanced Practice Registered Nurse or a collaborator, this step-by-step approach will support you in accurately filling out the necessary details for independent practice verification in Delaware.

Follow the steps to efficiently complete the form online.

1. Press the ‘Get Form’ button to access the document and open it in your preferred online editor.
2. Begin by entering the name of the Advanced Practice Registered Nurse in the designated field. If the APRN has a Delaware license, include the license number.
3. Input the collaborator's full name in the next section, ensuring all details are accurate.
4. In the Business/Practice Name section, provide the official name of the practice where the collaboration was made.
5. Enter the location address of the practice, making sure to avoid using a P.O. Box—include the main site if there are multiple locations.
6. Fill in the collaborator’s phone number and email address for direct communication.
7. Select the type of professional licensure that pertains to the collaborator. Indicate if they are a physician, podiatrist, or other, and provide the corresponding license number and specialty.
8. Identify the business/practice type that describes the collaborative agreement by checking all applicable boxes.
9. Indicate the APRN role for which the collaborator provided support by checking the appropriate option and selecting the relevant population focus area.
10. Complete the section on the APRN’s clinical practice hours by entering the total hours and the time period during which the collaboration occurred, specifying the month and year.
11. Sign the certification statement affirming the accuracy of the information provided, and put the date of signing.
12. Finally, ensure all corrections are made, save your changes, and prepare to print or share the completed form as necessary.

Complete your documents online today and ensure a smooth verification process.