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Form 186 - Fill Online, Printable, Fillable, BlankDocHub

Form 186 - Fill Online, Printable, Fillable, BlankDocHub 2026

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4.9 out of 5

56 votes

The document is a request form for verifying the ECFMG certification status of international medical graduates entering residency or fellowship programs in the U.S. It outlines the necessary information required to process the request, including personal details of the physician and the residency program. The form emphasizes that certification verification is essential for entry into accredited programs and licensure in the U.S., and it must be submitted with proper authorization from the physician.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your USMLE/ECFMG Identification Number in the designated field. Ensure that this number is accurate to avoid processing delays.
Fill in the physician’s name, including first, middle, and last names. Use clear and legible text for easy reading.
Provide your date of birth by selecting the appropriate day, month, and year from the dropdown menus.
Enter the residency program name and its corresponding Program ID Number as listed on the ACGME website.
Complete the address section where you want the status report sent. Include the hospital name, address, city, state, zip code, and contact details.
Ensure that a contact's name and title are provided along with their signature for authorization purposes.
Review all entered information for accuracy before submitting your request to ensure it is processed without issues.

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Versions	Form popularity	Fillable & printable
2020	4.9 Satisfied (56 Votes)
2016	4.4 Satisfied (26 Votes)
2008	4 Satisfied (50 Votes)

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