Get Kaper-1 2009-2025

The KAPER-1 form is essential for professional providers seeking evaluation and reevaluation in Kentucky. This guide provides a clear and detailed approach to completing the form online, ensuring users successfully navigate through its various sections.

Follow the steps to accurately complete the KAPER-1 form.

1. Use the ‘Get Form’ button to access the KAPER-1 online form and open it in the editor.
2. Begin with the personal identification data section. Fill in your name, including last, first, middle, and suffix if applicable. Provide your contact details including phone and fax numbers, as well as your primary, secondary, and billing office addresses.
3. Complete the credentialing section. Here, provide your credentialing contact details, preferred mailing address, and any relevant professional email addresses. Include your date of birth, gender, place of birth, marital status, and citizenship information.
4. Move to the educational data section. Detail your undergraduate and medical education, including the institutions attended, degrees obtained, and the duration of study. Be sure to clarify any name changes during your education.
5. For internships and residencies, list the names of institutions, types of training, and any relevant details on suspension or reprimand if applicable. Ensure you document all internships and residencies thoroughly.
6. Continue to the professional training, teaching appointments, and continuing education courses sections, accurately listing your experiences and any certifications held.
7. In the licensure information section, provide details of all current and past licenses, ensuring to include license numbers, dates issued, and statuses.
8. Answer the drug enforcement administration and state narcotics registration questions, including any relevant certificate numbers and expiration dates.
9. Fill out the professional liability data section, including carrier names, coverage amounts, and answer any questions regarding past claims or disputes.
10. Address authorization requirements in the last section by confirming accuracy, signing, and dating the form. This includes acceptance of terms related to your application.
11. Once all sections are completed, save your changes. You can then download, print, or share the KAPER-1 form as necessary.

Begin completing your KAPER-1 form online today for a smoother evaluation process.