Get Ia Icc Isupra 2013-2026

This guide provides step-by-step instructions for completing the Iowa Statewide Universal Practitioner Recredentialing Application (IA ICC ISUPRA) online. Follow these instructions carefully to ensure that your application is completed accurately and efficiently.

Follow the steps to successfully complete the application.

1. Click 'Get Form' button to access the application and open it in your preferred editor.
2. Begin by filling out your personal information in Section A, including your legal last name, first name, middle name, and professional title. Ensure you provide your Social Security Number and birth date in the specified format: Month/Date/Year.
3. Continue in Section A by listing any other known names and indicating your US citizenship status. If applicable, provide information about your Green Card or work permit.
4. Fill out your current home address and contact information, including your phone number, cell phone number, and email address. If applicable, include your spouse or significant other's full name.
5. Proceed to Section B, and provide details about your office or practice site information. This includes the practice location name, address, phone number, and billing information.
6. In Section C, list your current licensure and registration information, providing license numbers, issue dates, and expiration dates as required.
7. Complete Section D by providing details of your current malpractice liability coverage, including the carrier name, policy number, and coverage amounts.
8. In Section E, document your professional history, including all employment, academic, military, and public health positions added since your last credentialing cycle.
9. Fill out Section F with information on your hospital and facility privileges, ensuring to include details of each hospital, the type of privileges held, and contact information.
10. Complete Section G by listing all certifications achieved since your last credentialing cycle, along with the original certification date and expiration date.
11. In Section H, record additional education or training received since your last credentialing cycle, including institution name and contact details.
12. For Section I, provide names and contact information for three peer references who can comment on your clinical abilities and ethics.
13. Address the quality-focused questions in Section J, providing honest answers and explanations where required. Be thorough in your responses.
14. Finally, ensure you sign and date the application where indicated in the certification section. Review all entries for accuracy before submitting your application.
15. Once all changes are made, users can save the form, download it for your records, print it, or share it as needed.

Complete your IA ICC ISUPRA application online today to ensure a smooth credentialing process.