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Get Al J-1 Physian Practice Status Report 2011-2025
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How to fill out the AL J-1 Physician Practice Status Report online
Completing the AL J-1 Physician Practice Status Report is vital for physicians under the Alabama State-30 and ARC Waiver Programs. This guide will walk you through the process of filling out the report online with clear and helpful instructions.
Follow the steps to complete the report accurately and efficiently.
- Click ‘Get Form’ button to obtain the form and open it in the editing interface.
- Begin by entering your full name in the designated fields for Physician's Name: first name, middle initial, and last name.
- Select the type of service you provide by circling one of the options: primary care clinical practice, psychiatrist, primary care emergency department, or subspecialist in a specific field (not applicable to ARC).
- Indicate the number of practice sites where you have provided medical services during the report period.
- List each practice site’s name and full address, including street, city, county, state, and zip code. If there are additional sites, attach a separate sheet.
- Provide your practice phone number and email address for contact purposes.
- Choose the report number type you are submitting: initial report or one of the six-month reports up to the final report for 31-36 months. Record the corresponding dates of practice for the selected option.
- Detail your typical work schedule for the reporting period by listing hours worked each day of the week, including time spent on meal breaks, to calculate actual in-clinic work hours.
- Fill out the number of patients treated and necessary details for each category, including those who received various types of services and payment statuses.
- Enter your Medicare and Medicaid provider numbers, as well as the number of Alabama Medicaid Patient 1st participants you agree to accept.
- Certify the accuracy of your report by signing it and entering the date, telephone number, and email address.
- If applicable, have the sponsor or employer complete the second part of the form by providing their certification, signature, date, contact number, title, and email address.
- Once all sections are completed, save changes, download, print, or share the form as needed.
Complete your documentation online today for a smoother reporting process.
The HPSA score is a numerical rating that reflects the scarcity of healthcare resources in a specified area. Areas with higher scores qualify for additional healthcare support and attract more medical professionals. Understanding this score is essential for healthcare providers considering a J-1 waiver. Documenting the HPSA score properly in your AL J-1 Physician Practice Status Report can strengthen your application.
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