Maryland attestation form 2025

1. Click ‘Get Form’ to open the Maryland Attestation Form in our editor.
2. Begin by entering your name as it appears on your license in the designated field. This ensures accuracy in your application.
3. Fill in your home address, including city, state, and zip code. Make sure all information is typed correctly for clarity.
4. Provide your contact numbers: home phone, office phone (with extension if applicable), and cell phone or pager number.
5. Enter your email address to facilitate communication regarding your application.
6. Select all applicable Maryland Board certifications from the list provided. Ensure you include your RN or AC License number.
7. Type the name and license number of your physician collaborator as required. Remember, only one physician collaborator is needed.
8. In the declaration section, type your name again to affirm that all information is true and correct. This step is crucial for compliance.
9. Finally, sign and date the form using a digital signature feature available in our platform before saving a copy for your records.

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