Retainer Medical Practice Application: Form 440-2278 ... - Oregon.gov - oregon-2025

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by filling out the Applicant Information section. Enter your name, domicile, date established, and FEIN. Ensure all details are accurate for a smooth application process.
  3. Continue with the Assumed Business Name and Other Identities fields. Provide your mailing address and physical address, including city, state, and ZIP code.
  4. In the Experience and Expertise section, describe your background or training relevant to operating a retainer medical practice. Include any licenses held in other jurisdictions.
  5. Complete the Financial Responsibility section by indicating if you have filed for bankruptcy in the past 25 years and provide a detailed business plan as required.
  6. Finally, review the Applicant Attestations carefully. Ensure that all statements are true before signing and submitting your application.

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