Indiana state medical license

    • Indiana

      State Form 53877 (R2 / 3-18) INDIANA STATE DEPARTMENT OF HEALTH. DIVISION OF LONG TERM CARE Facility label. Date (month, day, year) FACILITY COMPLETES COLUMNS A, B, AND C. MAKE ADDITIONAL COPIES AS NEEDED. Include all contractual consultants. A. FULL NAME B. JOB TITLE C. START DATE (mm/dd/yyyy) D. LICENSE …

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    • [DOC File]Medical Licensing Board of Indiana

      https://info.5y1.org/indiana-state-medical-license_1_a60514.html

      If there is a positive response the license will not be issued until it has been reviewed by the Medical Licensing Board. FAIR INFORMATION PRACTICE ACT In compliance with IC 4-1-6, this agency is …

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    • [DOC File]Medical Licensing Board of Indiana

      https://info.5y1.org/indiana-state-medical-license_1_097181.html

      In addition to any medical license/permit etc., this also pertains to any professional health license such as an EMT, nursing, pharmacists, etc. You will need to print off the verification form; contact the …

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    • [DOC File]Medical Licensing Board of Indiana

      https://info.5y1.org/indiana-state-medical-license_1_1cc139.html

      The Medical Licensing Board of Indiana highly recommends and accepts the Federation Credentials Verification Service. You may apply for the FCVS packet through the Federation of State Medical Boards. Their website is www.fsmb.org. FOREIGN MEDICAL SCHOOLS. Adopted May 22, 2008. IC 25-22.5-3-1(c) DISSAPPROVED FOREIGN MEDICAL …

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    • [DOC File]KENTUCKIANA MEDICAL HEALTH ALLIANCE, RRG

      https://info.5y1.org/indiana-state-medical-license_1_e52445.html

      Indiana Medical License Number _____ Number of hours per week practicing in Indiana _____ Are you a member of your local and/or state medical society? IF THE ANSWER IS YES TO ANY OF THE …

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    • Indiana

      indiana state personnel department * The information on this form is Confidential and your Social Security number is being requested by this state agency in accordance with I.C. 5-10-8-7. Disclosure …

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    • [DOC File]VARICELLA CASE INVESTIGATION

      https://info.5y1.org/indiana-state-medical-license_1_d6bb54.html

      The certified provider must be a Medical Doctor (M.D.) or a Doctor of Osteopathic Medicine (D.O.) licensed to practice in the State of Indiana. The provider seeking certification must include his/her medical license number on the uniform stamp (see below), and the physician signing the application for certification must match the medical license …

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