MI LARA Certification of Appointment to a Michigan Training Hospital for a Medical Doctor License 2020 free printable template
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Bureau of Professional Licensing PO Box 30670 Lansing, MI 48909 Telephone: (517) 3350918 www.michigan.gov/bpl Data Michigan. Certification OF APPOINTMENT TO A MICHIGAN TRAINING HOSPITAL FOR A MEDICAL
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How to fill out MI LARA Certification of Appointment to a Michigan Training
How to fill out MI LARA Certification of Appointment to a Michigan Training Hospital
01
Obtain the MI LARA Certification of Appointment form from the Michigan Department of Licensing and Regulatory Affairs (LARA) website.
02
Fill in the name and address of the training hospital at the top of the form.
03
Provide the name and credentials of the trainee or resident in the designated section.
04
Specify the start and end dates of the training program.
05
Include details about the supervising physician, including their name, license number, and specialty.
06
Sign and date the form at the bottom as the authorized representative of the training hospital.
07
Submit the completed form to MI LARA either through mail or electronically as instructed.
Who needs MI LARA Certification of Appointment to a Michigan Training Hospital?
01
Individuals who are enrolling in a medical training program at a Michigan training hospital.
02
Residency programs that provide training in various medical specialties.
03
Supervising physicians who are overseeing residents or trainees at the training hospital.
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What is MI LARA Certification of Appointment to a Michigan Training Hospital?
The MI LARA Certification of Appointment to a Michigan Training Hospital is a formal document that certifies the appointment of a medical professional to a designated training hospital in Michigan, ensuring that they meet the required standards to provide medical training.
Who is required to file MI LARA Certification of Appointment to a Michigan Training Hospital?
Medical professionals who are appointed to a training program within a Michigan Training Hospital are required to file the MI LARA Certification of Appointment.
How to fill out MI LARA Certification of Appointment to a Michigan Training Hospital?
To fill out the MI LARA Certification of Appointment, you need to provide details such as the applicant's personal information, the training hospital's information, the specific training program, and the dates of appointment, then submit it to the state licensing agency.
What is the purpose of MI LARA Certification of Appointment to a Michigan Training Hospital?
The purpose of the MI LARA Certification of Appointment is to ensure that medical training programs in Michigan comply with state regulations and that appointed medical professionals are officially recognized for their training responsibilities.
What information must be reported on MI LARA Certification of Appointment to a Michigan Training Hospital?
The MI LARA Certification must report information such as the full name of the medical professional, their license number, the name and address of the training hospital, the duration of the appointment, and the specifics of the training program.
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