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EDUCATION PARTNER ATTESTATION FORM The American College of Emergency Physicians (ACEP) is committed to ensuring that all jointly provided activities are planned and implemented in accordance with
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How to fill out joint provider attestation form
How to fill out joint provider attestation form
01
Obtain the joint provider attestation form from the appropriate organization or website.
02
Fill out the provider information section with the necessary details such as name, address, and contact information.
03
Indicate the type of activity for which you are seeking joint provider status.
04
Include a detailed description of the educational activity being offered.
05
Provide information on how the educational activity will be evaluated and how outcomes will be measured.
06
Obtain signatures from all parties involved in the joint provider agreement.
07
Submit the completed form to the appropriate organization for approval.
Who needs joint provider attestation form?
01
Healthcare providers or organizations seeking to collaborate with other entities to offer continuing education activities.
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What is joint provider attestation form?
The joint provider attestation form is a document where two medical providers attest to sharing responsibility for a patient's care.
Who is required to file joint provider attestation form?
Any medical providers who are sharing responsibility for a patient's care are required to file the joint provider attestation form.
How to fill out joint provider attestation form?
To fill out the joint provider attestation form, both providers must include their information, sign the document, and provide details about the shared patient care.
What is the purpose of joint provider attestation form?
The purpose of the joint provider attestation form is to establish and document the shared responsibility of medical providers for a patient's care.
What information must be reported on joint provider attestation form?
The joint provider attestation form must include information about the two providers, details of the shared patient care, and signatures from both providers.
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