Get Pa Verification Of Opioid Education 2017-2025

The PA Verification Of Opioid Education form is essential for individuals seeking to validate their education in pain management and opioid prescribing. This guide provides a clear, step-by-step approach to filling out the form online, ensuring you complete it accurately and efficiently.

Follow the steps to successfully complete the verification form.

1. Click the ‘Get Form’ button to access the form and open it for editing.
2. In Section 1, provide your personal information. Fill in your last name, first name, middle name, any other names you may have used, the last four digits of your Social Security Number, date of birth, and your license number. Also, include your full address, city, state, and ZIP code.
3. Proceed to Section 2, which needs to be completed by a dean, registrar, or program director. Provide the name of the educational institution, full address, city, state, and ZIP code.
4. The responsible official must certify that you have successfully completed the required education. They will document the completion date in the fields for the month, day, and year.
5. The official will then sign the form to certify the information is correct and true based on their review of your records.
6. Date the certification to validate when it was signed.
7. Once the form is fully completed, ensure it is submitted directly to the Pennsylvania State Board of Osteopathic Medicine at the specified address.
8. After completing the form, you may save your changes, download the form, print it, or share it as necessary.

Complete your PA Verification Of Opioid Education form online today for a seamless submission process.