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> Medical credentialing
Medical credentialing
Personal Information
Full name
Date of birth
Social Security number
Contact information
Address
Phone number
Email address
Education and Training
Medical school attended
Graduation date
Residency program
Fellowship program (if applicable)
Continuing medical education (CME) courses completed
Professional Licenses
State medical licenses
List all states where you hold or have held a medical license
DEA (Drug Enforcement Administration) registration
Board certifications
Specify specialties and certification dates
Work History
Current employer
Address
Phone number
Employment start date
Previous employers
List all previous employers in chronological order
Include dates of employment, job titles, and responsibilities
Professional References
Reference 1
Name
Contact information
Relationship to applicant
Reference 2
Name
Contact information
Relationship to applicant
Reference 3
Name
Contact information
Relationship to applicant
Insurance and Malpractice Coverage
Professional liability insurance carrier
Policy number
Coverage dates
Claims history
Include any past malpractice claims or lawsuits
Documentation
Curriculum Vitae (CV)
Medical school diploma
Residency and fellowship completion certificates
State medical licenses
Board certifications
CME certificates
Professional reference letters
Malpractice insurance certificate
Additional Requirements
Background check
Drug screening
Immunization records
CPR certification
HIPAA training completion certificate
Remember, this is just a sample checklist and the actual requirements for medical credentialing may vary depending on the organization or institution.
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