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The Oregon Practitioner Application form is a crucial document for healthcare professionals seeking credentialing and recredentialing within the state. Established under House Bill 2144 in 1999, this form is developed by the Advisory Committee on Physician Credentialing Information (ACPCI). It ensures that practitioners meet the necessary standards set by hospitals and health plans. The application includes several key sections, such as practitioner information, specialty details, board certifications, and practice information. Applicants must provide accurate and current details, including their professional liability action history, and submit supporting documents like state licenses and DEA certificates. Clear instructions are provided for completion, emphasizing the importance of legibility and adherence to the specified format. Each page requires initials and the date of the last review, ensuring that all information remains up-to-date. By following the guidelines outlined in the application, practitioners can facilitate a smoother credentialing process, ultimately contributing to the quality of care delivered in Oregon's healthcare system.

Common mistakes

  1. Incomplete Information: Failing to fill out all sections of the application can lead to delays. Each part is essential for the review process, and missing information may result in an application being rejected or returned.

  2. Incorrect Signatures: Not signing and dating the required pages is a common oversight. Both the Attestation Questions and the Authorization and Release of Information Form need to be signed to validate the application.

  3. Using an Invalid Format: Modifying the wording or format of the application can invalidate it. It is crucial to use the application as provided without alterations.

  4. Neglecting to Attach Required Documents: Failing to include necessary documents, such as state licenses or DEA certificates, can hinder the processing of the application. Each submission must include all requested documentation.

  5. Forgetting to Initial Pages: Each page of the application requires the applicant's initials and the date of the last review. Omitting this step can lead to confusion about the application’s status.

  6. Providing Outdated Information: Submitting outdated or inaccurate information can cause significant issues. Ensure that all details are current and reflect the applicant's status accurately.

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Listed Questions and Answers

What is the purpose of the Oregon Practitioner Application form?

The Oregon Practitioner Application form is designed to facilitate the credentialing and recredentialing process for healthcare practitioners within the state. Established by House Bill 2144 in 1999, this application is utilized by hospitals and health plans to ensure that practitioners meet necessary qualifications and standards. The Advisory Committee on Physician Credentialing Information (ACPCI) oversees the development and approval of this uniform application.

What documents must be submitted along with the application?

When submitting the Oregon Practitioner Application, it is essential to include current copies of several documents. These include:

  • State Professional License(s)
  • DEA Certificate or CSR Certificate (if applicable)
  • ECFMG certificate (if applicable)
  • Face Sheet of Professional Liability Policy or Certificate

Additionally, if any section of the application does not apply to you, simply check the provided box at the top of that section.

How should the application be completed and submitted?

The application should be typed or legibly printed in black or blue ink. It is crucial to complete the application in its entirety, as modifications to the wording or format will invalidate it. After filling out the application, retain an unsigned and undated copy for your records. Send the completed application to the healthcare organization you are applying to, ensuring that all information is accurate and current.

What should I do if I need more space for my answers?

If the space provided in the application is insufficient for your answers, you can attach additional sheets. Be sure to reference the specific question you are answering on these additional sheets to maintain clarity and organization.

Is a curriculum vitae required with the application?

A curriculum vitae is optional when submitting the Oregon Practitioner Application. However, it is important to note that it does not serve as an acceptable substitute for the required documentation. Ensure that all necessary documents are included to avoid delays in the credentialing process.

Form Specifications

Fact Name Description
Governing Law The Oregon Practitioner Recredentialing Application is established under Oregon House Bill 2144 (1999).
Application Purpose This application is used for credentialing and recredentialing practitioners by hospitals and health plans in Oregon.
Submission Guidelines Applicants must submit the completed application to the specific health care organization, not to the State of Oregon.
Signature Requirement Applicants must sign and date specific pages of the application, including the Attestation Questions and Authorization and Release of Information Form.
Initials Requirement Each page of the application requires the applicant’s initials and the date of the last review.
Document Submission Current copies of specific documents, such as state professional licenses and DEA certificates, must accompany the application.
Modification Policy Any modifications to the wording or format of the application will invalidate it.
Optional Curriculum Vitae A curriculum vitae is optional but not an acceptable substitute for the information requested in the application.