Get Sts Members Mentor The Next Generation Of Ct Surgeons - Sts

Filling out the STS Members Mentor The Next Generation Of CT Surgeons form is an essential step for participants in the Society of Thoracic Surgeons program. This guide provides clear instructions to ensure you can complete the form accurately and efficiently.

Follow the steps to complete the form successfully.

1. Click ‘Get Form’ button to access the document and open it for editing.
2. In the Participant ID section, enter your unique identifier where indicated. This helps in tracking your individual data within the STS National Database.
3. Proceed to the section titled "Consent and Release". Carefully read through the permissions being granted to STS and DCRI regarding your data submission to the Centers for Medicare and Medicaid Services.
4. Sign the document in the area labeled 'Surgeon Signature' to indicate your agreement with the terms outlined in the form.
5. Fill in your full name under 'Surgeon Name', your street address under 'Surgeon Street Address', and the required fields for your National Provider Identifier (NPI) and Tax Identification Number (TIN). Ensure these details are accurate and current.
6. Enter the date of completion in the 'Date' field. This denotes when you are officially submitting your consent.
7. Provide a valid email address in the 'Email Address' section for future correspondence related to your submission.
8. Review the completed form for accuracy. Upon verifying that all information is correct, proceed to save your changes.

Get started on completing your form online today!