Get Re-credentialing Checklist

This guide provides detailed instructions to help users effectively complete the RE-CREDENTIALING CHECKLIST online. Whether you have experience with forms or are filling one out for the first time, this guide aims to support you through each step of the process.

Follow the steps to accurately fill out the RE-CREDENTIALING CHECKLIST.

1. Click the ‘Get Form’ button to access the RE-CREDENTIALING CHECKLIST and open it in your online editor.
2. Begin by entering your name and contact information. Make sure to fill in all fields marked as required, including your address, phone number, email address, and date of birth.
3. Proceed to the section for attaching documents. Ensure you have the completed skills checklist and copies of your current curriculum vitae and relevant certification documents ready for upload.
4. Next, fill in your medical license information. Provide copies of all active state medical licenses, controlled substance registrations, and federal DEA certificates if applicable.
5. Include personal identification by uploading a current photo signed and dated in the margin, and attach a copy of your driver's license or passport.
6. Complete the practice experience section, listing all locations where you have worked in the past three years. Be prepared to explain any gaps in employment exceeding 60 days.
7. Document your hospital affiliations, including the names and addresses of hospitals where you held privileges in the past three years.
8. In the certification section, list all boards and certifications held over the past three years, detailing the issuing board, dates issued, and expiration dates.
9. List any professional memberships in the professional societies section, and provide details of all licenses held, both active and inactive.
10. Provide references, ensuring you include those who have worked with you in the past year and detail their relationship to you.
11. Complete the sections on continuing medical education and any disciplinary actions you may have faced. Be thorough in your explanations, particularly in sensitive areas.
12. If you have a history of malpractice claims, ensure you provide accurate details in the malpractice claims history section.
13. Once all information is entered and verified for accuracy, save your changes. You will then have the option to download, print, or share your completed RE-CREDENTIALING CHECKLIST.

Take the first step toward completing your RE-CREDENTIALING CHECKLIST online today.