Document Checklist for Provider OnBoarding
Please take a minute to review this checklist to ensure all documents are available for uploading before beginning application.
Document Checklist
- Copies of ALL current healthcare licenses
- Copy of DEA registration (if applicable)
- Copy of State Controlled Substance registration (if applicable)
- Copy of MD/RN/CRNA Diplomas
- Copy of ECFMG (if applicable)
- Copy of DD214 (if applicable)
- Copy of Medical School Training Certificates (MD only if applicable)
- Copy of Anesthesiology Board Certification (MD only)
- Current copy of malpractice insurance (COI) showing policy limits, expiration date and your name as the insured provider
- Last 10 years of malpractice insurance (if applicable)
- Explanation of any malpractice claims (if applicable)
- Procedure/Activity logs for the last 2 years
- Copies of CME/CE for the last 2 years
- Copy of ACLS/PALS/BLS
- Copy of Driver’s license
- Copy of Social Security Card
- Copy of current TB
- Copy of current Flu Shot
- Copy of Immunizations
- Current Photograph
- Pre-Application Questions Completed
- Basic Details In Progress
- Clinical Work History Missing Info
- Education Completed
- CME Not Started
- Licenses Not Started
- Certifications Not Started
- Professional Liability Insurance Not Started
- Claims History Not Started
- References Not Started
- Attetation Questions Not Started
- Background Check Not Started
- Acknowledgments Not Started
- Confidentiality Agreement Not Started
- Information Release Not Started