Get the free Additional Practice Location Notification andor Change of Address - oregonobo

OREGON BOARD OF OPTOMETRY CHANGE OF ADDRESS NOTIFICATION Licensee Name: PRACTICE LOCATION Change of Primary License Number: ADDRESS OF RECORD all mail from Board Change or New Additional Location*

How to fill out additional practice location notification

To fill out an additional practice location notification, follow these steps:

1. Start by obtaining the necessary form from your relevant governing body or regulatory agency. This form is typically available on their website or can be obtained through their offices.
2. Begin by providing your personal information, such as your name, address, contact details, and any identification numbers or licenses relevant to your profession. This information helps identify you as the person submitting the notification.
3. Clearly indicate the primary practice location that you are currently registered or licensed to operate from. This is typically your main place of business or the location where you primarily provide services.
4. Next, you will need to provide details about the additional practice location(s) you wish to notify. Include the name, address, and contact information of each location, along with any relevant licenses or permits required to operate at these locations.
5. Ensure that you provide a detailed description of the services or activities that will be conducted at each additional practice location. This helps the governing body or regulatory agency understand the nature of your practice and ensure compliance with any applicable regulations or guidelines.
6. If there are any relevant dates or time frames associated with the additional practice location(s), such as temporary or seasonal operations, make sure to include this information as well.
7. Finally, review your completed form for accuracy and completeness. Ensure that all required fields are filled out properly and that you have provided all necessary supporting documents or attachments.

Who needs an additional practice location notification?

1. Healthcare professionals: Medical doctors, dentists, nurses, specialists, and other healthcare professionals who operate from multiple locations may need to submit an additional practice location notification.
2. Allied health professionals: Occupational therapists, physical therapists, speech-language pathologists, psychologists, and other allied health professionals who offer services at various locations may also be required to submit this notification.
3. Other licensed professionals: Professionals in fields such as law, architecture, engineering, accounting, and real estate may need to notify regulatory bodies of any additional practice locations where they provide services.

Remember to verify the specific requirements with your governing body or regulatory agency, as the process and documentation may vary based on your profession and jurisdiction.

For pdfFiller’s FAQs

What is additional practice location notification?

Additional practice location notification is a requirement for healthcare providers to inform the relevant authorities about any additional locations where they provide medical services.

Who is required to file additional practice location notification?

All healthcare providers who practice at multiple locations are required to file additional practice location notification.

How to fill out additional practice location notification?

Additional practice location notification can usually be filled out online or through a specific form provided by the regulatory body.

What is the purpose of additional practice location notification?

The purpose of additional practice location notification is to ensure that all healthcare providers are properly registered and monitored at each location where they practice.

What information must be reported on additional practice location notification?

The information reported on additional practice location notification typically includes the name of the provider, the address of the additional location, and the type of services provided.

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