Get the free Washington physician application fillable form - lni wa

Thank you Provider Credentialing F248-011-000 Non-Network Provider Account Application 01-2013 Application Instructions Complete the application using 12 point font or clearly print using dark ink.

How to fill out washington physician application form

How to fill out Washington physician application form?

1. Start by carefully reading and understanding the instructions provided with the application form. This will ensure that you are aware of all the necessary information and supporting documents required.
2. Gather all the required documents, such as your medical degree, residency or fellowship certificates, and any additional certifications or licenses.
3. Fill out the personal information section of the application form accurately. Provide your full name, contact details, social security number, and any other requested information.
4. Provide information about your education and training. Include details about the medical school you attended, any specialized training or fellowships completed, and any previous positions held.
5. Fill out the work history section, providing details about your past employment in the medical field. Include the name of the organization, your position, and the dates of employment.
6. Complete the section that addresses your medical license information. Provide details about the states or countries where you currently hold a license to practice medicine.
7. Submit your malpractice insurance information, ensuring that you include the policy number, coverage dates, and the name of the insurer.
8. Include information about any disciplinary actions or malpractice claims that have been filed against you. Be honest and provide all relevant details, as withholding this information could have serious consequences.
9. If applicable, provide information about any hospital privileges, board certifications, or academic appointments you hold.
10. Carefully review the completed application form for accuracy and completeness before submitting it. Ensure that all necessary signatures are included.

Who needs Washington physician application form?

1. Individuals who are seeking to become licensed physicians in the state of Washington need to complete the physician application form.
2. Physicians who are already licensed in another state but wish to practice medicine in Washington need to fill out the application form to obtain a Washington medical license.
3. Medical professionals who have previously held a Washington medical license but let it lapse need to complete the application form for reinstatement.

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What is washington physician application form?

The Washington physician application form is a document that physicians are required to complete in order to apply for a license to practice medicine in the state of Washington.

Who is required to file washington physician application form?

Any physician who wishes to practice medicine in the state of Washington is required to file the Washington physician application form.

How to fill out washington physician application form?

To fill out the Washington physician application form, physicians must provide personal information, such as their name, contact information, and medical education history. They must also provide documentation of their medical training and any relevant certifications or licenses. Additionally, they may be required to provide information about their past employment history and any disciplinary actions taken against them.

What is the purpose of washington physician application form?

The purpose of the Washington physician application form is to gather important information about physicians who wish to practice medicine in the state. This information is used to assess the qualifications and competency of the applicant and determine if they meet the state's licensing requirements.

What information must be reported on washington physician application form?

On the Washington physician application form, physicians must report their personal information, medical education history, training, certifications, licenses, and employment history. They may also be required to report any disciplinary actions taken against them.