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How to use or fill out the Confirmation of Standing form

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Click ‘Get Form’ to open it in the editor.
Begin with Part A, where you will provide your consent to release information. Fill in the name of the region, province, state, or country where your medical licensing authority is located.
Enter your full name, license number, and address in the designated fields. Ensure that all information is accurate and complete.
Sign and date the form at the bottom of Part A to authorize the release of your information.
Proceed to Part B. Here, the medical licensing authority will confirm your qualifications. Ensure they fill in details such as your full name, graduation date, license types, and any specialty qualifications.
The licensing authority must answer questions regarding any inquiries or investigations related to professional conduct. If applicable, they should provide supporting documents.
Finally, ensure that an official from the medical licensing authority signs and dates the form before affixing their seal or stamp.

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