Follow the steps to complete the ASDIN PD Recertification Form efficiently.

1. Click ‘Get Form’ button to access the form. This will allow you to open it in your preferred online editor.
2. Begin by checking the appropriate technique(s) you are applying for: Fluoroscopic Technique or Peritoneoscopic Technique.
3. Fill in your identifying information accurately, including your last name, first name, middle name, date of birth, citizenship, and NPI number.
4. Input your home address, including city, state, and zip code.
5. Provide practice information by entering the name and address of the facility where you are credentialed to perform PD catheter placements.
6. Indicate your preferred mailing address for receiving your certificate by selecting either your home address or practice address.
7. Mark your type of practice—either private practice or academic medicine.
8. List your current medical facility affiliations, marking whether you are credentialed at each facility.
9. Sign and date the application to certify that all provided information is correct.
10. After completing the form, ensure all documentation, including case logs and proof of CME, is attached. You can then save, download, print, or share your form as needed.

Complete your ASDIN PD Recertification Form online now to ensure your certification remains valid.