Get the free Non-Physician Affiliate Application - acponline
Show details
This document is an application form for non-physician affiliate membership to the American College of Physicians (ACP) for licensed healthcare professionals in the U.S. It requires personal and professional
We are not affiliated with any brand or entity on this form
Get, Create, Make and Sign non-physician affiliate application
Edit your non-physician affiliate application form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share your form instantly
Email, fax, or share your non-physician affiliate application form via URL. You can also download, print, or export forms to your preferred cloud storage service.
How to edit non-physician affiliate application online
To use the professional PDF editor, follow these steps below:
1
Register the account. Begin by clicking Start Free Trial and create a profile if you are a new user.
2
Prepare a file. Use the Add New button to start a new project. Then, using your device, upload your file to the system by importing it from internal mail, the cloud, or adding its URL.
3
Edit non-physician affiliate application. Rearrange and rotate pages, add new and changed texts, add new objects, and use other useful tools. When you're done, click Done. You can use the Documents tab to merge, split, lock, or unlock your files.
4
Save your file. Select it from your records list. Then, click the right toolbar and select one of the various exporting options: save in numerous formats, download as PDF, email, or cloud.
It's easier to work with documents with pdfFiller than you could have believed. You may try it out for yourself by signing up for an account.
Uncompromising security for your PDF editing and eSignature needs
Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
How to fill out non-physician affiliate application
How to fill out Non-Physician Affiliate Application
01
Obtain the Non-Physician Affiliate Application form from the relevant authority.
02
Fill out your personal information, including name, address, and contact details.
03
Provide details about your professional background and certification.
04
List your employment history, including the names of healthcare facilities where you have worked.
05
Include information about any relevant training or continuing education courses you have completed.
06
Submit additional documentation as required, such as copies of certifications or identification.
07
Review your application for completeness and accuracy before submission.
08
Submit the application by the specified deadline, following any guidelines for submission.
Who needs Non-Physician Affiliate Application?
01
Non-physician healthcare professionals who wish to work in clinical settings and need to be recognized as affiliates.
02
Individuals seeking privileges to perform specific tasks or services under the supervision of a physician.
03
Healthcare workers transitioning into a non-physician affiliate role within healthcare organizations.
Fill
form
: Try Risk Free
People Also Ask about
Which of the following is not an example of a non-physician provider?
The answer is A. Licensed Practical Nurse (LPN), as LPNs provide basic medical care under supervision and do not have the same independent capabilities as Nurse Practitioners, Physician Assistants, and Certified Nurse-Midwives.
What is a nonparticipating physician?
Nonparticipating physicians, or NonPARs, are healthcare providers who have chosen not to enter into contractual agreements with insurance companies or government payers. They do not have predetermined fee schedules or agreed-upon reimbursement rates with the insurance companies.
Who is considered a non-physician?
Services rendered by Non-Physician Medical Practitioners (NMPs) are covered by Medi-Cal. NMPs consist of Physician Assistants (PAs), Nurse Practitioners (NPs) and Certified Nurse Midwives (CNMs). Billing guidance for Licensed Midwives (LMs) are also listed in this section.
What is a non-physician specialty?
Some examples of non-physician providers include: Registered nurses. Nurse practitioners. Physician assistants. Clinical nurse specialists.
What is considered a non-physician specialty?
Some examples of non-physician providers include: Registered nurses. Nurse practitioners. Physician assistants.
What is a qualified non-physician healthcare professional?
NMPs consist of Physician Assistants (PAs), Nurse Practitioners (NPs) and Certified Nurse Midwives (CNMs). Billing guidance for Licensed Midwives (LMs) are also listed in this section.
For pdfFiller’s FAQs
Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.
What is Non-Physician Affiliate Application?
The Non-Physician Affiliate Application is a form used to register non-physician healthcare providers who work in conjunction with physicians to deliver care.
Who is required to file Non-Physician Affiliate Application?
Non-physician healthcare providers such as nurse practitioners, physician assistants, and other allied health professionals who work under the supervision of a physician are required to file this application.
How to fill out Non-Physician Affiliate Application?
To fill out the Non-Physician Affiliate Application, candidates must provide personal information, professional credentials, employment history, and details about their supervising physician, as well as any required supporting documentation.
What is the purpose of Non-Physician Affiliate Application?
The purpose of the Non-Physician Affiliate Application is to ensure that non-physician healthcare providers are properly credentialed and authorized to practice within a healthcare setting, promoting quality care and safety.
What information must be reported on Non-Physician Affiliate Application?
The application typically requires personal identification details, licensing and certification information, professional qualifications, employment history, and any disciplinary actions or criminal history.
Fill out your non-physician affiliate application online with pdfFiller!
pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.
Non-Physician Affiliate Application is not the form you're looking for?Search for another form here.
Relevant keywords
Related Forms
If you believe that this page should be taken down, please follow our DMCA take down process
here
.
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.
