Get Niw - New Hampshire Department Of Health And Human Services - Dhhs Nh

This guide provides comprehensive instructions on how to fill out the NIW form from the New Hampshire Department of Health and Human Services. Follow the detailed steps to ensure a smooth and accurate submission.

Follow the steps to effectively complete the NIW form online.

1. Press the ‘Get Form’ button to acquire the NIW form and open it in your preferred editor.
2. Begin with the physician information section. Fill in your name, practice or specialty, birth date, and both home and practice site addresses. Ensure that all personal details are accurate to prevent any delays.
3. Provide your home and work phone numbers, along with your email address. This information is essential for contact purposes.
4. Enter the start and end dates for your J-1 visa waiver employment, as well as for your NIW employment. These dates must align with your work schedule.
5. Detail your daily office hours for the week, including time allocated for administrative tasks. Be sure to specify both your start and end times.
6. Indicate whether you are New Hampshire Board Certified, and if applicable, provide the expiration date of your certification.
7. Answer the questions regarding any previous licenses issues or felony convictions. Attach an explanation if you answer 'yes' to any of these questions.
8. Fill in the employer information section, describing the payor mix in the last six months percentage-wise, detailing Medicaid, Medicare, and other sources.
9. Confirm whether the J-1 physician has maintained appropriate licensure under New Hampshire law and describe any restrictions affecting their duties.
10. Certify that the physician is employed and providing primary care services, including the employer's signature and date.
11. Once you have completed all sections, review the form for accuracy. After thorough verification, you can save your changes, download, print, or share the completed form.

Complete your NIW form online now to ensure timely processing of your application.