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How to use or fill out SUB-021 - Appendix B without Buttons doc
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- In the first section, enter the Program License Number at the top of the document. This is essential for identification.
- Select whether this application is for an Initial or Renewal by checking the appropriate box.
- List licensed physicians on call by entering their names and license numbers in the designated fields. Ensure accuracy as this information is crucial.
- Sign and date the application in the provided signature block. Remember, you can type your signature for electronic submission, which holds the same validity as a handwritten one.
- As a representative of the governing authority, ensure that you sign and print your name in the respective fields, confirming compliance with licensing standards.
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