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Click ‘Get Form’ to open the Verification of Opioid Education Form in our editor.
In Section 1, enter your personal information including your last name, first name, middle name, other names, last four digits of your SSN, date of birth, license number, and address. Ensure all details are accurate for verification purposes.
Proceed to Section 2 where the Dean or Registrar must complete the educational verification. They should provide the name of the school/program and its address. This section also requires confirmation that you have completed at least 2 hours in pain management and addiction identification.
The Dean or Registrar must sign and date the form to certify that all information is true and correct. Make sure they understand the importance of this certification.
Once completed, save your document and return it directly to the Pennsylvania State Board of Osteopathic Medicine as instructed.

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