SUB-021 - Appendix B without Buttons doc 2026

1. Begin by opening the form in our platform. Click ‘Get Form’ to access the editor.
2. In the first section, enter the Program License Number at the top of the document. This is essential for identification.
3. Select whether this application is for an Initial or Renewal by checking the appropriate box.
4. List licensed physicians on call by entering their names and license numbers in the designated fields. Ensure accuracy as this information is crucial.
5. 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.
6. 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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