Credentialing checklist template 2025

1. Click ‘Get Form’ to open the credentialing checklist template in the editor.
2. Begin with Section II: Identifying Information. Fill in your last name, first name, middle initial, and other names used. Ensure accuracy as this information is crucial for verification.
3. Proceed to Section III: Practice Information. Enter details about your office manager and the Tax Identification Number (TIN) associated with your practice.
4. In Sections IV and V, provide your pre-medical and medical/professional education details. Include school names, degrees received, and graduation dates.
5. Complete Sections VI through XIII by detailing your internships, residencies, board certifications, medical licenses, and professional liability insurance. Be thorough to avoid delays in processing.
6. Finally, review all sections for completeness. Use the editor's features to make any necessary adjustments before saving or submitting your form.

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