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California participating physician application

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The document is a comprehensive application form for physicians seeking participation in a California healthcare organization, specifically HDNFMC / IPA. It includes detailed instructions for completion, sections for personal and professional information, medical education, practice details, board certifications, professional liability insurance, current affiliations, peer references, work history, and attestation questions regarding the physician's qualifications and any legal issues. Additionally, it contains addenda for health plans and explanations of any professional liability actions.

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