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Me9048r Advisory Committee on Physician Credentialing Information (ACPCI) - Oregon Practitioner Recr

Me9048r Advisory Committee on Physician Credentialing Information (ACPCI) - Oregon Practitioner Recr 2026

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The document is the Oregon Practitioner Recredentialing Application, established by House Bill 2144 in 1999. It outlines the process for practitioners to apply for credentialing and recredentialing with hospitals and health plans in Oregon. The application requires detailed personal, professional, and educational information, including licensing, certifications, work history, and peer references. It emphasizes the importance of accuracy and completeness in submissions and includes sections for attestation of qualifications and authorization for information release.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your full legal name in the 'Practitioner Information' section. Ensure you include any suffixes and provide your contact details accurately.
Proceed to the 'Specialty Information' section. Indicate your primary clinical specialty and check if you wish to be designated as a primary care practitioner.
In the 'Board Certification/Recertification' section, list all current and past certifications. If necessary, attach additional sheets for more information.
Complete the 'Practice and Employment Information' section with details about your primary practice, including contact numbers and addresses.
Review each section carefully, ensuring all fields are filled out completely. Remember to initial each page and sign where required before submission.

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Me9048r Advisory Committee on Physician Credentialing Information (ACPCI) - Oregon Practitioner Recr 2026

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Me9048r Advisory Committee on Physician Credentialing Information (ACPCI) - Oregon Practitioner Recr 2026

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