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- Click ‘Get Form’ to open the verification mr in the editor.
- Begin with Section #1, Demographic Info. Fill in your name, sex, mailing address, city/state/zip, telephone, email, and optional social security number. Ensure all fields marked with a red * are completed.
- Proceed to Section #2, Medical Education. Enter your valid medical license number and field of certification. List your medical school(s), internship/residency programs, and fellowship program details.
- In Section #3, CME Credit Requirements, document your Category I CME credits related to cardiac MRI education. Include the name of the program, dates attended, and credits earned.
- For Section #4, Documentation of CMR exams, provide details of institutions where you interpreted cases. Include the number of cases for both thoracic and cardiac MRI along with signatures from authorized personnel.
- Finally, review all sections for accuracy before submitting your application through our platform.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2019 | 4.8 Satisfied (85 Votes) |
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