Follow the steps to effectively complete the recredentialing application.

1. Click ‘Get Form’ button to obtain the form and open it in an online editor.
2. Begin by filling in your personal information in the Practitioner Information section. Include your full legal name, any other names used, contact details, and social security number. Ensure all details are accurate and current.
3. Proceed to Specialty Information. Indicate your primary clinical specialty and any additional specialties. You will also specify whether you would like to be designated as a primary care practitioner.
4. Complete the Board Certification/Recertification section by listing all current and past certifications. If you are not currently certified, provide details regarding your certification intentions.
5. In the Practice and Employment Information section, provide details about your primary practice or affiliation. Include contact information, the type of entity, and your primary office details.
6. Fill out the sections for Practice Call Coverage and Additional Education as necessary. List any additional training or residencies completed within the last three years.
7. In the Continuing Medical Education section, document any CME activities attended within the past two years, providing the name, date attended, and credits earned.
8. Complete the Health Care Licensure and Other State Licenses sections by listing all relevant licenses and their details.
9. Document your Professional Practice/Work History over the past three years, ensuring to account for any gaps.
10. In the Peer References section, list three references who can attest to your clinical skills and qualifications.
11. Complete the Professional Liability Insurance section by providing details about your current and past insurance coverage.
12. Finally, review and answer the Attestation Questions section carefully, certifying that all the information provided is accurate.
13. Sign and date the application to affirm your statements. Ensure all required attachments are included before submitting.
14. After submission, you can save your progress, download a copy, or print the completed form for your records.

Start completing your OR MSC 9048R online today to ensure timely recredentialing!