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Kentucky Application for Provider Evaluation and Reevaluation

Kentucky Application for Provider Evaluation and Reevaluation 2025

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4.8 out of 5

60 votes

The document is a comprehensive application form for provider evaluation and reevaluation in Kentucky, dated April 2009. It collects detailed personal identification data, educational background, professional training, licensure information, and professional liability data from healthcare providers. The form also includes sections for peer references, professional employment history, and certifications. Additionally, it requires applicants to disclose any legal or disciplinary issues related to their medical practice. The purpose of the application is to assess the qualifications and credentials of healthcare providers seeking appointment or reappointment to medical staff.

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2009	4.8 Satisfied (60 Votes)

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