Medco 13 2006 form-2025

See details

4.2 out of 5

68 votes

The document outlines the application process for provider enrollment and certification (MEDCO-13) with the Ohio Bureau of Workers' Compensation (BWC) as part of the Health Partnership Program (HPP). It details the requirements for providers to become certified, including necessary documentation, licensing, and compliance with state regulations. Additionally, it includes a declaration regarding material assistance to terrorist organizations, emphasizing the importance of truthful responses in the application process.

Here's how it works

01. Edit your medco 13 online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send medco 13b via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out medco 13 2006 form with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the MEDCO-13 in the editor.
Begin with Section 1, where you will select your provider type. Check the box that corresponds to your classification and complete the relevant sections as instructed.
Move to Section 2 for General Information. Fill in your current BWC provider number, business name, tax identification number, and contact details. Ensure accuracy as this information is crucial for processing.
In Section 3, provide individual provider information including board certifications and DEA numbers if applicable. Attach any required documentation such as proof of certification.
Proceed to Section 4 and answer all questions truthfully. If you answer 'yes' to any question, provide a detailed explanation on a separate sheet.
Finally, complete Section 5 by signing the application/agreement. Ensure all required documents are attached before submitting your application.

Start using our platform today for free to streamline your MEDCO-13 form completion!

See more medco 13 2006 form versions

We've got more versions of the medco 13 2006 form form. Select the right medco 13 2006 form version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (272 Votes)
2018	4.3 Satisfied (49 Votes)
2012	4.4 Satisfied (162 Votes)
2009	4.4 Satisfied (513 Votes)
2006	4.2 Satisfied (68 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Can I type my eSignature on my medco 13 2006 form?

Sure, a typed name is accepted as a legitimate electronic signature when you create it on your form utilizing a compliant solution like DocHub. Simply add your medco 13 2006 form to our editor, click Sign in the top tool pane → Create your signature → Type your name in the appropriate tab, and decide how it will appear on your document.

How do you create an e-signature for the medco 13 2006 form on iOS?

Apart from an extensive toolset for editing PDFs on mobile phones, DocHub enables you to sign your medco 13 2006 form along the way. Open our editor in your web browser, make changes using DocHub’s toolset, and complete your editing by eSigning the finished form.