Get the free New Locum Provider Form - Samaritan Health Plans - providers samhealthplans
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SPECIAL INVESTIGATION FORM FOR OFFICE USE ONLY:For help with completing this form, please call: 5417684550 or toll-free at 18008324580, M F, 8 AM to 8 PM. TTY users should call 18007352900. TELL US
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01
Obtain the new locum provider form from the appropriate department or organization.
02
Read the instructions carefully to understand the information and documents required.
03
Fill in your personal details such as name, address, contact information, and any relevant identification numbers.
04
Provide your qualifications, including educational background, certifications, and licenses.
05
Indicate the dates and duration of availability for locum work.
06
Provide a brief summary of your experience and skills as a locum provider.
07
Attach any supporting documents or records, such as a resume, credentials, or references.
08
Double-check the form for accuracy and completeness.
09
Submit the filled-out form according to the given instructions, either electronically or physically.
10
Follow up with the department or organization to ensure that your form has been received and processed.
Who needs new locum provider form?
01
The new locum provider form is typically needed by healthcare facilities and medical organizations that are seeking to hire or contract locum tenens providers. These may include hospitals, clinics, private practices, and other healthcare settings.
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What is new locum provider form?
The new locum provider form is a form used to report information about a temporary healthcare provider who is filling in for a regular provider.
Who is required to file new locum provider form?
Medical facilities and healthcare organizations are required to file the new locum provider form.
How to fill out new locum provider form?
The new locum provider form can be filled out online or submitted via mail with all the required information about the temporary healthcare provider.
What is the purpose of new locum provider form?
The purpose of the new locum provider form is to ensure that temporary healthcare providers are properly documented and accounted for.
What information must be reported on new locum provider form?
The new locum provider form must include the name, contact information, licensure, and length of time the temporary provider will be working.
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