Get Ok Odh Form 606 2013-2025

Filling out the OK ODH Form 606 is a critical step for healthcare professionals seeking credentialing. This guide will provide you with clear and supportive instructions on how to complete each section of the form online.

Follow the steps to accurately fill out the OK ODH Form 606 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with Section 1, Personal Information. Fill in your name, last, first, middle, and suffix as applicable. Include your professional degree, gender, and any other names by which you have been known, along with the dates this name was used.
3. In this section, also enter your Social Security Number, NPID, date of birth, place of birth, visa type, citizenship status, and any relevant Medicare and Medicaid numbers.
4. Proceed to Section 2, Directory Information. Provide your mailing address for all credentialing correspondence, including street address, city, state, zip code, and appropriate contact numbers.
5. Continue filling in your office address and billing address if applicable, ensuring to capture all necessary contact details.
6. Move to Section 3, Current Professional Practice. Denote your primary and secondary specialty, and indicate your willingness to accept new patients and any affiliations with healthcare associations.
7. In Section 4, Education, list all medical and graduate professional schools attended along with the years you were enrolled and any degrees awarded. Be sure to provide complete contact information for each institution.
8. Section 5 focuses on training, including previous internships, residencies, or fellowships. Make sure to document all relevant programs, their locations, and the dates attended.
9. Continue onto Section 6, Academic Appointments. List your past and present positions along with the inclusive dates of service for each.
10. In Section 7, provide details about your healthcare affiliations, listing all hospitals or health systems with which you have been associated.
11. Section 8 requires you to document your professional work history thoroughly, ensuring to account for any gaps in employment.
12. In Section 9, list all professional licenses, registrations, and certifications, including dates of issue and expiration.
13. Proceed to Section 10 to detail any additional certifications and registrations. Answer questions regarding current board certifications as applicable.
14. In Section 11, provide office information for your primary and secondary offices, including operational details and hours.
15. Ensure to check off the required documents in Section 12 that you are attaching with your application.
16. Review and complete Section 13, Attestation, carefully signing and dating the document to confirm its accuracy.
17. If needed, utilize Section 14 for any additional information or explanations relevant to your application.
18. Once you have filled out all sections, you can save changes, download, print, or share the completed form as per your requirement.

Begin filling out the OK ODH Form 606 online to ensure your credentialing process is completed efficiently.