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PURPOSE: ESTABLISHED BY HOUSE BILL 2144 (1999), THE ADVISORY COMMITTEE ON PHYSICIAN

PURPOSE: ESTABLISHED BY HOUSE BILL 2144 (1999), THE ADVISORY COMMITTEE ON PHYSICIAN-2026

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The document is the Oregon Practitioner Credentialing Application, established by House Bill 2144 in 1999. It outlines the process for practitioners to apply for credentialing and recertification with hospitals and health plans in Oregon. The application includes sections for personal information, professional history, education, certifications, practice details, peer references, and attestation questions regarding the practitioner's qualifications and any legal issues. It emphasizes the importance of providing accurate information and authorizes the investigation of the applicant's credentials.

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Click ‘Get Form’ to open the Oregon Practitioner Credentialing Application in the editor.
Begin by filling out your personal information in the 'Practitioner Information' section. Ensure you provide your full legal name, contact details, and any other names used.
Proceed to the 'Specialty Information' section. Indicate your principal clinical specialty and any additional specialties. Check if you wish to be designated as a primary care practitioner.
In the 'Professional Practice/Work History' section, chronologically list all relevant work experiences since completing postgraduate training. Be thorough and include contact details for each employer.
Complete the 'Attestation Questions' section carefully, answering each question truthfully. If applicable, provide additional sheets for explanations.
Finally, review all sections for accuracy and completeness before signing and dating the application at the end.

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PURPOSE: ESTABLISHED BY HOUSE BILL 2144 (1999), THE ADVISORY COMMITTEE ON PHYSICIAN-2026

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