Get Ky Kaper-1 2007

The KY KAPER-1 form is essential for health care providers seeking reappointment for privileges at health care facilities in Kentucky. This guide provides a clear, step-by-step approach to completing the form online, ensuring that all users, regardless of their legal experience, can navigate the process with confidence.

Follow the steps to complete the KY KAPER-1 form effectively.

1. Press the ‘Get Form’ button to access the KY KAPER-1 form, which you can fill out in an online editor.
2. Begin with Part I, Personal Identification Data. Fill in your name, suffix, degrees, and contact information including phone and fax numbers for both your primary and secondary offices. Ensure that each field is accurate and complete.
3. For teaching appointments, list any relevant positions held including the department, appointment type, and contact information. Complete all date fields in MM/YY format.
4. Move to the post-graduate and continuing education courses section. Indicate whether you have participated in courses in the last three years and provide any supporting documents if applicable.
5. In the licensure information area, list all current and past professional health care licenses, ensuring to attach copies of all active licenses.
6. Complete the drug enforcement administration information by providing your current Federal DEA certificate numbers and expiration dates.
7. Address the professional liability data section by answering questions regarding any past claims or issues with your liability insurance in the last two years.
8. Proceed to certification questions to indicate your board certifications and related information.
9. Answer questions in the individual practice information and personal health status sections, providing detailed explanations where necessary.
10. For professional employment and affiliations, list all relevant positions held chronologically and include complete contact details.
11. Provide two peer references who can affirm your clinical abilities and ethical character, along with their contact information.
12. Finally, review all information for accuracy and completeness. Once filled, you can save your changes, download, print, or share the document as needed.

Complete your KY KAPER-1 document online today to ensure a smooth reappointment process.