ࡱ> (*%&' bjbjWW Tt==6$PW#O]ZYoooJJJ\\\\\\\^aX\O0JJO0O0\oo ]O7O7O7O0oo\O7O0\O7O7fTpXo00\H1v0WD\]0O]tWas2taXX&a"YJ"O7|'8+JJJ\\4hJJJO]O0O0O0O0aJJJJJJJJJ :   INCLUDEPICTURE "cid:image001.jpg@01CCD516.EBEDAA80" \* MERGEFORMATINET  Credentials Verification OfficeSection VPolicy 1 TITLE: Verification for Medical Staff Initial Appointment (MD, DO, DPM, DMD) Date of Implementation: July 1, 2000Revised: 9/6/00; 10/19/00, 11/2/00; 3/17/02; 11/5/02; 11/14/03; 11/12/04; 11/1/05; 11/17/06; 11/17/07; 11/17/08; 11/17/09; 2/23/10; 11/10; 11/11; 5/12; 11/12; 5/21/13, 11/13 Date of Last Review: 11/2013 Signed Original on File at the CVO Office Signature: _____________________________  The UPMC Credentials Verification Office (UPMC CVO) will provide centralized application processing and credentials verification services for the facilities and organizations of the University of Pittsburgh Medical Center (UPMC). Verification services will be provided in accordance with applicable law and regulation and accrediting body standards, including, but not limited to the Pennsylvania Department of Health (DOH), the Department of Public Welfare (DPW), The Joint Commission (TJC), the American Osteopathic Association (AOA), and the National Committee for Quality Assurance (NCQA). For Medical Staff initial appointment, primary source verification is performed to confirm the following credentials: Valid, unrestricted license to practice License Sanctions Valid DEA Board Certification Malpractice Insurance and History Medical Education Training Programs Hospital Affiliations Professional Activities and Work History Military Service Teaching Appointments Peer References Competence Evaluation Medicare/Medicaid Sanctions Criminal Background Check A listing of each element that will be primary source verified and the accepted primary sources can be found in the Verification Sources policy. When written verification is requested, an addressed return envelope is provided. NOTE: All documents and verification responses are imported or scanned into the MSO software. The document and response images can be viewed or printed. (See the Document Scanning policy). I. Licensure Standard/Requirement- Copy of current signed license (display copy). - Verification of current licensure.Notes- If the license expires after the application is in process, the copy of the license and PSV must be current when verification is confirmed complete. - Dates on the ID Number tab are not changed until the verification response is received. - State License is the PA license and the license for any other state where practicing. - One and only one license must be designated as primary. - A trainee license is not valid for hospital privileges. Do not enter on ID number screen and do not scan. - An institutional license is acceptable for some facilities. Request the letter. Verify from the State website. - An MD may have an acupuncturist (AK) license in addition to the MD license. Obtain copies and verify. - A DMD and DDS may have 2 licenses dentist (DS) and dental anesthesia (DA or DP or DN). Obtain copies and verify both. Pennsylvania Preferred Verification Source/MethodWebcrawl import of verification response from PA license verification website at http://licensepa.state.pa.us/ into scanned images.Alternate Verification Source/MethodTelephone verification. Call number as listed below and have the license number available. Complete the verbal verification form and scan as the response. MD - (717) 783-1400 DO - (717) 783-4858 DMD/DDS - (717) 783-7162 DPM - (717) 783-4858Alternate Verification Source/MethodFax or mail verification. Print and fax the license verification letter to the PA Bureau of Professional and Occupational Affairs Health Licensing Division at (717) 787-7769 or mail to the address listed below. No consent and release form is required. Commonwealth of Pennsylvania Department of State Bureau of Professional and Occupational Affairs Board of (appropriate Board) P.O. Box 2649 Harrisburg, PA 17105 Ohio Preferred Verification Source/MethodMD, DO, DPM - Webcrawl import of verification response from Ohio license verification website at  HYPERLINK http://www.state.oh.us/med www.state.oh.us/med into scanned images. DMD/DDS - Internet Grabber import of verification response from Ohio license verification website at  HYPERLINK http://www.state.oh.us/den www.dental.ohio.gov into scanned images.Alternate Verification Source/MethodNo verbal verifications will be given. Alternate Verification Source/MethodMail requests with fee. No consent and release form is required. Print and send the license verification letter to The State of Ohio Medical Board 77 S. High Street 18th Floor Columbus, OH 43266  West Virginia Preferred Verification Source/MethodWebcrawl import of verification response from WV license verification website at www.wvdhhr.org/wvbom/ into scanned images.Alternate Verification Source/MethodVerbal Verification. Complete the verbal verification form and scan. MD - only three names per day to (304) 558-2921. DO (304) 723-4638. DMD/DDS (304) 252-8266.Alternate Verification Source/MethodMD, DPM Mail requests with fee. No consent and release form is required. Print letter and mail to West Virginia Board of Medicine 101 Dee Drive Charleston, WV 25311 DMD/DDS mail requests no fee. No consent and release form is required. Print letter and mail to Dentists & Dental Hygienists, Board of Examiners P.O. Drawer 1459 Beckley, WV 25802-1459 DO Mail requests with fee. No consent and release form is required. Print letter and mail to Board of Osteopathic Medicine 334 Penco Road Weirton, WV 26062-3813 D. New York Preferred Verification Source/MethodWebcrawl import of verification response from NY license verification website at www.op.nysed.gov/opsearches.htm into scanned images.Alternate Verification Source/MethodMail requests with fee. No consent and release form is required. Print letter and mail to New York State Education Department Office of the Professions State Education Building 2nd Floor 89 Washington Avenue Albany, New York 12234  II. Licensure Sanctions Standard/RequirementVerification of license sanctions.Preferred Verification Source/MethodMD, DO FSMB. Verification once per week via website at  HYPERLINK "http://www.drdata.org" www.drdata.org. Initiation of verification process will initiate the request. Using Batch Update, a comment and date of query is entered on the ID Tab under the User Defined field. The task on the process must be manually completed. For information found, document to be scanned. Original FSMB reports on file for reference. DPM, DMD/DDS direct from State Board (See license verification).  DEA Certification Standard/Requirement- Copy of current certificate. - Verification of current DEA certification.Notes- If the DEA expires after the application is in process, the copy of the DEA and PSV must be current when the verification is confirmed complete. (Unless the new DEA has just been obtained and the current DEA cannot be verified). -A DEA certificate and verification must be obtained for all states where practicing. - Dates on the ID Number tab are not changed until the verification response is received.Preferred Verification Source/MethodNational Technical Information Service. Webcrawl import of verification response from NTIS web site at  HYPERLINK http://www.deanumber.com www.deanumber.com into scanned images. Alternate Verification Source/MethodIn an emergency situation, if the DEA number is known, Internet Grabber import of verification response from  HYPERLINK "https://www.deadiversion.usdoj.gov/webforms/validateLogin.jsp" https://www.deadiversion.usdoj.gov/webforms/validateLogin.jsp Local office (412) 777-1870. Board Certification Standard/Requirement- Copy of current certificate or letter (if available) - Verification of current Board Certification.Notes- Recognized Boards only. Board certification from outside the USA is not recognized and not verified. - If the Board certification expires after the application is in process, the copy of the certificate and PSV must be current when the verification is confirmed complete. (Unless the new certification has just been obtained and the verification is not available on the Website.) - If a fee is indicated on the Specialty screen, place letter, consent/release and check request in the accounts payable box. If .99 is indicated in the fee field, follow the instructions in the comment field on the table screen. - Dates on the Specialty tab are not changed to reflect the current dates of the certification until the verification response is received. - If the certification does not expire, do not enter an expiration date, check the lifetime box. - If a copy of the Board certificate cannot be obtained after 2 attempts, the comment requested 2 times unable to obtain is entered on the task and the task is completed. A. MD/DO Preferred Verification Source/MethodABMS CertiFACTS On-Line Verification. Webcrawl import of verification response from ABMS web site at www.certifacts.org into scanned images.  Alternate Verification Source/MethodDirect to Boards with approved verification. (Refer to verification sources policy) B. DO Preferred Verification Source/MethodAmerican Osteopathic Association Physician Master File. Log onto the AOA website at  HYPERLINK http://www.aoa-net.org www.aoa-net.org. Fee payable by credit card. Internet Grabber import of verification response. C. DPM Preferred Verification Source/MethodAmerican Board of Podiatric Surgery Log onto the ABPS website at www.abps.org. Fee payable by credit card. Internet Grabber import of verification response. American Board of Podiatric Medicine Log onto the ABPM website at www.abpm.org. Fee payable by credit card. American Board of Lower Extremity Surgery verification by fax only. Print letter. Fax letter, attestation, and copy of certificate to (248) 855-7743. American Board of Multiple Specialties in Podiatry call for verbal verification (888)852-1442. D. DMD/DDS Preferred Verification Source/MethodAmerican Board of Oral and Maxillofacial Surgery. Log onto the ABOMS website at  HYPERLINK "http://www.aboms.org" www.aboms.org. Click on verification of certification status. Enter SS# of practitioner. If name does not display, written verification must be done. Fee payable by credit card. Internet Grabber import of verification response. American Board of Oral and Maxillofacial Pathology. Log onto the ABOMS website at  HYPERLINK "http://www.aboms.org" www.aboms.org to obtain verification. Fee payable by credit card. American Board of Pediatric Dentistry. Log onto the ABPD website at  HYPERLINK "https://www.abpd.org/Verification-Request.aspx" https://www.abpd.org/Verification-Request.aspx to obtain verification. Fee payable by credit card. American Board of Orthodontics. Log onto the ABO website at  HYPERLINK "http://www.americanboardortho.com" www.americanboardortho.com to obtain verification. Fee payable by credit card. V. Malpractice Insurance and History Standard/Requirement- Copy of current malpractice insurance facesheet. - Verification of current malpractice insurance. - Verification of 10 year history of claims.Notes- Malpractice claims history is requested for 10 years if the practitioner graduated from the education/training program more than 10 years ago or the period beginning with graduation from the education/training program if the practitioner graduated less than 10 years ago. - If the malpractice expires after the application is in process, the copy of the malpractice facesheet must be current when the verification is confirmed complete. The verification is not redone unless requested by the facility. - On expiration, dates on the Insurance tab are not changed to reflect the current dates of the insurance until the copy is received. When the copy is received, the dates on the malpractice tab and the image tab are updated. - All PSD practitioners working exclusively in PA must have Tri-Century insurance. Enter as the current insurance on the insurance screen even if not listed on the application. PSD practitioners working in both Ohio and PA will have Medical Protective Insurance. - The malpractice facesheet stating that it is only effective in the training program is not acceptable for hospital privileges. A. Tri-Century Preferred Verification Source/Method- Do not attempt to verify or request verification until the current facesheet is obtained. - Once the facesheet is obtained, access the Tri-Century database. - If the verification for the practitioner is found, print the verification. If all 4 questions are answered no, scan the verification. If any question is answered yes, or if only two questions are answered, run the Tri-Century Request report and e-mail to the Tri-Century contact person. - If the verification for the practitioner is not found, run the Tri-Century Request report and e-mail to the Tri-Century contact person. - If 2 policies need to be verified, note in the subject line of the e-mail request.Alternate Verification Source/Method- If the database cannot be used and the verification must be obtained immediately, run the Tri-Century Request report and e-mail to the Tri-Century contact person with urgent request in the subject line. - If a second request letter is generated, run the Tri-Century Request report and e-mail to the Tri-Century contact person with second request in the subject line. - If there is no response to the second request, an e-mail is sent to the Tri-Century Coordinator indicating the dates of the previous requests and requesting an investigation. - The verifications for the last 6 months are available on the shared drive in the PSV Tri-Century folder B. Other Carriers Preferred Verification Source/Method- Print and send the request letter with a copy of the consent/release attached. - If a fee is indicated on the Insurance screen, place letter, consent/release and check request in the accounts payable box. If .99 is indicated in the fee field, follow the instructions in the comment field on the table screen.Alternate Verification Source/MethodIf first and second requests have been ignored or if needed immediately, fax the letter with the consent/release attached. VI. Medical, Osteopathic, Podiatric or Dental Education Standard/Requirement- Copy of certificate of completion. (If available). - Verification of completion.Notes- If verification previously done and in the scanned images, no additional verification is necessary. Link the verification response to the image response tab. - If a fee is indicated on the Credentials screen, place letter, consent/release and check request in the accounts payable box. If .99 is indicated in the fee field, follow the instructions in the comment field on the table screen. - For University of Pittsburgh programs, print the letter, attach the consent/release and place in the appropriate mail bin. - A copy of the medical school diploma is requested with the first and second missing letters. If still unable to obtain, the task may be completed without the certificate. A. MD Preferred Verification Source/MethodUS Medical School (including Canada and Puerto Rico) print and send letter to institution with copy of consent/release attached. Foreign Medical School - print and send letter to institution with copy of consent/release attached. If no response after 2 attempts and ECFMG is verified, no additional attempts are necessary. Link the verification response of Foreign Education/Training document from O to the response image tab. The comment ECFMG is entered. Access the ECFMG Website at  HYPERLINK "http://www.ecfmg.org/" www.ecfmg.org/ and follow the directions on the screen.Alternate Verification Source/MethodAMA Physician Master File log onto the website at  HYPERLINK "http://www.ama-assn.org/amaprofiles" www.ama-assn.org/amaprofiles to request a profile. Fee payable by credit card. Must purchase a report for each facility. The report is not sharable. Report can be view in 5 minutes to 24 hours. Internet Grabber import of verification response. For questions or problems, phone 1-800-665-2282. If comment being reverified is on the report, the verification cannot be used and must be requested. US Medical School www.degreeverify.com. Log onto the Degreeverify website. Internet Grabber import of verification response. A .99 in the fee field will indicate a comment on the table entry. Do not send letter. School will not verify. Foreign Medical School If the practitioner indicates that they have a FCVS report, ask the physician to have FCVS send a sealed official copy addressed directly to the CVO. An unsealed copy sent by the physician is not acceptable as verification. B. DO Preferred Verification Source/MethodPrint and send letter to institution with consent/release attached.Alternate Verification Source/MethodAOA Physician Master File - Internet Grabber import of verification response from the web site at  HYPERLINK http://www.aoa-net.org www.aoa-net.org. Foreign Medical School If the practitioner indicates that they have a FCVS report, ask the physician to have FCVS send a sealed official copy addressed directly to the CVO. An unsealed copy sent by the physician is not acceptable as verification. C. DMD/DDS Preferred Verification Source/MethodPrint and send letter to institution with consent/release attached. DPM Preferred Verification Source/MethodPrint and send letter to institution with consent/release attached. Training Programs Standard/Requirement- Copy of certificate of completion. - Verification of completion of internship, residency and fellowship programs. All begun and/or completed must be verified.Notes- For residency or fellowship, if less than 5 years since graduation, a program director evaluation must be obtained. If the verification is returned without the evaluation, enter the program director as a program director evaluation in the peer references tab and send the letter with the consent/release attached. If the Program Director Evaluation includes verification of dates of training, it may also be used as verification of training. For University of Pittsburgh programs, request the program director evaluation when the process is initiated. - The copy of the certificate of completion is requested in the first and second missing letters. If still unable to obtain, the task may be completed without the certificate. - If verification previously done and in the scanned images, no additional verification is necessary. Link the verification response to the image response tab. - If foreign program has been completed, 2 attempts will be made to obtain verification. No additional attempts will be made if a two-year residency has been completed in the USA. Link the verification response of Foreign Education/Training document from O to the response image tab. The comment foreign rule is entered. - If a fee is indicated on the Credentials screen, place letter, consent/release and check request in the accounts payable box. If .99 is indicated in the fee field, follow the instructions in the comment field on the table screen. - For University of Pittsburgh programs, print the letter, attach the consent/release and place in the appropriate mail bin. - If currently in training and verification of completion of the program is the last item needed, the process can be completed. A. MD Preferred Verification Source/MethodPrint and send letter to institution with consent/release attached.Alternate Verification Source/MethodAMA Physician Master File log onto the website at  HYPERLINK "http://www.ama-assn.org/amaprofiles" www.ama-assn.org/amaprofiles to request a profile. Fee payable by credit card. Must purchase a report for each facility. The report is not sharable. Report can be view in 5 minutes to 24 hours. Internet Grabber import of verification response. For questions or problems, phone 1-800-665-2282. If comment being reverified is on the report, the verification cannot be used and must be requested. US Medical School www.degreeverify.com. Log onto the Degreeverify website. Internet Grabber import of verification response. A .99 in the fee field will indicate a comment on the table entry. Do not send letter. School will not verify. Foreign Medical School If the practitioner indicates that they have a FCVS report, ask the physician to have FCVS send a sealed official copy addressed directly to the CVO. An unsealed copy sent by the physician is not acceptable as verification. B. DO Preferred Verification Source/MethodPrint and send letter to institution with consent/release attached.Alternate Verification Source/MethodAOA Physician Master File - Internet Grabber import of verification response from the web site at  HYPERLINK http://www.aoa-net.org www.aoa-net.org. US Medical School www.degreeverify.com. Log onto the Degreeverify website. Internet Grabber import of verification response. A .99 in the fee field will indicate a comment on the table entry. Do not send letter. School will not verify. Foreign Medical School If the practitioner indicates that they have a FCVS report, ask the physician to have FCVS send a sealed official copy addressed directly to the CVO. An unsealed copy sent by the physician is not acceptable as verification. C. DDS/DMD Preferred Verification Source/MethodPrint and send letter to institution with consent/release attached.Alternate Verification Source/MethodUS Dental School www.degreeverify.com. Log onto the Degreeverify website. Internet Grabber import of verification response. A .99 in the fee field will indicate a comment on the table entry. Do not send letter. School will not verify. D. DPM Preferred Verification Source/MethodPrint and send letter to institution with consent/release attached.Alternate Verification Source/MethodUS Podiatric School www.degreeverify.com. Log onto the Degreeverify website. Internet Grabber import of verification response. A .99 in the fee field will indicate a comment on the table entry. Do not send letter. School will not verify. Hospital Affiliations Standard/RequirementVerification of hospital affiliations for the past 10 years or 10. (unless required to verify a gap in professional activities and work history)Notes- Hospital affiliation is not verified for facilities where the practitioner is applying. Although indicated on the front of the CIF, the facility is not entered as an affiliation until the practitioner status is changed to an active status (active, interim, provisional). - A roster may not be used to verify an initial Medical Staff application unless the cover letter clearly states that a response to an individual request will not be sent. - Online verifications can be obtained from participating UPMC hospitals by accessing the UPMC psv website. - If a fee is indicated on the Hospitals screen, place letter, consent/release and check request in the accounts payable box. If .99 is indicated in the fee field, follow the instructions in the comment field on the table screen. - A list of facilities requiring a stamped return envelope is posted by the mailing desk. - Check Hospitals screen for requests that are e-mailed. - Do not reverify prior hospital affiliations if a thru date has been entered and a verification obtained previously is linked. - Moonlighting affiliations are verified. - Urgent care facilities are entered as offices and are not verified.Preferred Verification Source/Method- Whenever possible, E-mail the letter to the facility with consent/release attached. - Print and mail letter to the facility with consent/release attached.Alternate Verification Source/MethodPrint and fax the letter and consent/release to the facility. X. Professional Activities and Work History Standard/RequirementVerification of work history for physicians is usually not obtained. However, work history verification for a physician is obtained to verify a gap that cannot be otherwise verified.Notes- All entries on the Professional Activities and Work History chronology are to be entered on the Work History screen unless already entered on the credentials or hospitals screen. - A gap analysis is done. Any gap of greater than 3 months must have an explanation.Preferred Verification Source/MethodIf employment is to be verified to verify a gap, add the task to the process, print and send a letter with the consent/release attached to the employer.  X. Military Service Standard/RequirementVerification of military service within the past 10 years. (unless required to verify a gap in professional activities and work history) Preferred Verification Source/MethodPrint and mail letter to the institution with consent/release attached.Alternate Verification Source/MethodRequest a copy of the Physicians Discharge Papers (DD214). Print and mail the letter to Military Records Center (for most verifications) 9700 Page Boulevard St. Louis, MO 63132 See information on CVO Shared Drive for addresses applicable to other specific military circumstances. Teaching Appointments (or academic appointments or faculty appointments) Standard/RequirementVerification of current teaching appointment. (Prior teaching appointments are not verified unless required to verify a gap in professional activities and work history)Notes- Only the current appointment is verified. - Every active/active physician at PUH is required to have a teaching appointment. Even if not listed on the application or CV, enter a teaching appointment and verify. - Every Pitt teaching appointment should have an expiration date according to the verification received. If the date on the verification is expired by more than one year, make the teaching appointment prior. - If a verification is needed outside of the verification process, forward to the Lead Credentialing Coordinator.Preferred Verification Source/MethodPrint and mail letter to the reference with the confidential peer evaluation form and the consent/release attachedAlternate Verification Source/MethodPrint and fax letter to the reference with the confidential peer evaluation form and the consent/release attachedAlternate Verification Source/MethodE-mail the letter to the reference with the confidential peer evaluation form and the consent/release attached University of Pittsburgh Preferred Verification Source/MethodMD/DO - Send letter to Physician Services Division (41206) first to verify all UPMC facility appointments. If no response, send to University of Pittsburgh (2463). If no response, send to the specific facility. Mail bins are to be used for PSD & Pitt requests. DMD - Send letter to with consent/release attached to University of Pittsburgh School of Dental Medicine 420 Salk Hall Pittsburgh, PA 15261 Alternate Verification Source/MethodCall (412) 648-2030 and complete verbal verification letter on the CVO Shared Drive  Peer References Standard/RequirementVerification of 3 peer references.Notes- A peer is defined as having the same education/degree as the applicant (MD and DO are equivalent). - Reference must have worked directly with the applicant in the last 24 months. If a peer reference does not meet the requirement, a new peer reference must be requested. (The question must be answered on the reference form.) - At least one peer must be from the same specialty. - All questions must be answered individually, completely and explanations included for any Fair or Poor responses. - The peer references listed on the application must be obtained. If a reference is to be substituted (practitioner out of country, unavailable, etc), the reason for the substitution must be documented. The documentation is to be scanned as peer reference specified. If the application is received with no references listed, the names and addresses must be documented when obtained and scanned as peer reference specified. - A picture of the applicant is attached to each verification request sent. - If a reference previously obtained is no more than 3 months old on the day the application is processed, and includes the photo recognition question, the reference does not need to be requested again. - If a reference is received that contains information of a sensitive or confidential nature, it is to be e-mailed to the Medical Staff Coordinator(s) directly as a priority e-mail with the subject urgent confidential matter. A document is scanned into images stating that due to the sensitive or confidential nature of the information that it was e-mailed directly to the facilities instead of scanned into images.Preferred Verification Source/MethodPrint and mail letter to the reference with the confidential peer evaluation form and the consent/release attachedAlternate Verification Source/MethodPrint and fax letter to the reference with the confidential peer evaluation form and the consent/release attachedAlternate Verification Source/MethodE-mail the letter to the reference with the confidential peer evaluation form and the consent/release attached Clinical Competence Evaluation Standard/RequirementVerification of clinical competenceNotesThe evaluation is sent to the practitioner listed on the Competence Designation Form. A peer reference and/or Program Director evaluation should not be sent to the practitioner designated for the competence evaluation. The competence evaluation is entered as a peer reference. The verification method must be letter (print). If the practitioner does not have a Privilege Form, then a competence evaluation is not required. Delete the task from the process.Preferred Verification Source/MethodPrint and mail letter to the designated practitioner with the competence evaluation form, the consent/release and the privilege form attachedAlternate Verification Source/MethodPrint and fax letter to the designated practitioner with the competence evaluation form, the consent/release and the privilege form attachedAlternate Verification Source/MethodE-mail the letter to the designated practitioner with the confidential peer evaluation form, the consent/release and the privilege request attached Print the letter with the evaluation form and consent attached Scan into images as A CVO Request Use combined images to create a pdf to send sequence the letter first the DOP Request second Click on the combined image and create an e-mail to send  Medicare/Medicaid Sanctions Standard/RequirementVerification of Medicare/Medicaid sanctions.Preferred Verification Source/MethodOffice of the Inspector General. Webcrawl import of verification response from OIG web site at  HYPERLINK "http://exclusions.oig.hhs.gov\\home.html" http://exclusions.oig.hhs.gov\home.html into scanned images. If there is a name match, search by SS# to confirm there is no match, print, sign and scan the letter from the OIG Query task. Criminal Background Checks Standard/RequirementCriminal background check including social security number trace and 7 year history of criminal convictions.Notes- Must have signed authorization prior to requesting. If a facility requests a CBC outside of a current process, the facility must obtain and supply the CVO with the CBC Authorization. - The CBC is obtained only once. If obtained previously and the report is in the scanned images, check the item off as complete on the task list. The CBC can be redone on an initial application if requested by a facility and the authorization has been signed.Preferred Verification Source/Method- Request to be sent via e-mail from the drop down reports on the practitioner task list. E-mail request to  HYPERLINK "mailto:documentation@hireright.com" documentation@hireright.com. The task CBC Request Sent is completed after the request submitted e-mail is received from Hireright. When the report is completed, Hireright notifies the requestor via e-mail. The completed report can be accessed by clicking on the link contained in the email or by accessing  HYPERLINK "https://ows01.hireright.com/login/" https://ows01.hireright.com/login/. Download and Open (do not just print) the report. Review the grid on page 1 of the report. If the grid displays Data Found on the SS Trace only, scan the report and complete the task. If the grid says Data Found for any other product, give the report to the Lead Coordinator or designee to clarify the results before scanning and completing the task. - The Act 34 PATCH report is received by the CBC requestor in a separate email from Hireright for any practitioner with a PA address. The subject of the email will read: Healthcare Statewide Criminal Results. The attachment is to be printed and scanned as Act 34 PATCH. Because this is direct from the verification source, the original document does not need to be witnessed. - For customer service issues, e-mail customerservice@hireright.com      PAGE 1 Section VPolicy 1 TITLE: Verification for Medical Staff Initial Appointment (MD, DO, DPM, DMD) KNOPSrstuv  < K ] ^ f p q r s u }  |vppj]hq~?hB*CJph hCJ h1M|CJ hgCJ hUCJ h}YCJ h ECJ hc5 hc5CJ hcCJ+h7hc5CJ$OJQJmH nH sH tH  hcCJ$hch~LOJQJaJh~LCJaJh~Lh~LmHnHujh~LUmHnHu$h7h~LCJaJmH nH sH tH $OPstuv~ul^^^r$If^r` $$Ifa$qkd? $$Ifl40$`\ 04 lalf4$If $Ifgd~L $Ifgd~L lkd$$Ifl4F<$ 0    4 lalf4r$If^r`  < r A[kd$$Ifl$$04 lal$If[kd$$Ifl$$04 lal  = > ? @   & + 5u ʶylhhhdhdh`h\h\hXhhQy/hUh9Fhhch,hcB*CJph h^9CJ hUCJ hcCJh,hnB*CJphh^9B*CJphhB*CJphhpB*CJphh7B*CJphhcB*CJphhnB*CJphhh,B*CJphh,B*CJphh]:B*CJphh>B*CJph"  = > $Ifgd[kda$$Ifl$$04 lal$If> ? @ 3 E O c & F hnkd$$Ifl0x$xr04 lal 5QklOP3d$If ! `^`` & F h  Sb%6:@Tktm}IL(1YvwCKnpx%&'jhcCJUjhcCJU he-CJhXGh[hcB*CJphh[hc>*B*CJph h>CJ hnCJ hznCJ hDCJ h`+CJ hUCJ h%$CJ hcCJhch53'Y~~~m~~~~^$If^`^gdzn^$If^`^$Iflkd$$Ifl0@ 3$~ 04 la. }ww$If^  & F` !lkdl$$Ifl0@ 3$~ 04 la.Mbw$Iflkd$$Ifl0@ 3$p04 la<,IWmttfttf\ 4$If`4 $If^` z$If^z` $If^$Iflkd$$Ifl0@ 3$p04 la< mnoqrwxQR {{{{$If^ & F`lkd1$$Ifl0@ 3$p04 la< ':;IO\fsXY~13Td|ƫwq hs"cCJh[hD>*B*CJphhc)>*B*CJph hcCJH* h~CJhchS~0JCJhc)0JCJjhS~CJU hS~CJjhS~CJU he-CJ h>CJ hQCJ hDCJ hcCJjhcCJUhc0JCJ,  0W$Ifokdn$$Ifl0@ 3$p04 la<WX~,:RS $If^$Ifokd $$Ifl0@ 3$p04 la< STUcd}oicc$If !  & F !`kd$$IflF@ 3$&=p0    4 la<+p $IfgdD$IflkdS$$Ifl0@ 3$p04 la<_`G[vw  !$If$Iflkd$$Ifl0@ 3$p04 la<|  (7\ko|! .!E!P!a!l!!!!f"h"k"""d#y##ޗ~q~hphnB*CJphhphcB*CJph h5CJ h kCJ h}_CJhc0JCJjhcCJUjhcCJU hcCJH*h[hc>*B*CJphhc)>*B*CJph hnCJ h>CJhc h +CJ hcCJ h~CJ,w '()6i[Q  !^ !0^`0lkd$$Ifl0@ 3$p04 la< !`p H $Ifgd +  !$If$If67\cd  {{  !$Iflkd$$Ifl0@ X"p04 la<$If !      5 X $If !lkd$$Ifl0@ X"p04 la<X Y ~ %"&"i"j"$IflkdF$$Ifl0@ 3$~ 04 la.j"k"l"m""""""|vvv$If & F 8!` !lkd$$Ifl0@ 3$~ 04 la."""#%$$vvh^$If^`^^$If^`^gdn$Ifqkd5$$Ifl0@ X"~ 04 la.#####$$%$'$~$$$$$$$ %%2%3%4%E%F%T%Z%%%%%%&ɼض~qbXKhq~?hdB*CJphhdB*CJphjhdB*CJUphhq~?hB*CJphhq~?hcB*CJphhc0JCJjchcCJUjhcCJU hJCJ h>CJ hcCJhphB*CJphhph5B*CJphhphcB*CJphhph5B*CJphhphnB*CJph$$$]%$Ifqkd$$Ifl0@ X"~ 04 la.]%^%%|&~&&~~ $Ifgdd$Ifqkd0$$Ifl0@ X"~ 04 la.&<&=&z&{&|&}&&&&&&&&&&O''5(J(K((( )))**s****9+:+;+F+++++++{uo h>CJ hdCJhCJ^JhcCJ^J h}_CJ hS!CJhchXG hcCJhhc5B*CJphhq~?hB*CJphhq~?hcB*CJphhq~?hZB*CJphh {6hd0JCJjhdB*CJUphhdB*CJph)&&&&&&&'/'qkkk$If & F 8!>^`> !tkd$$IflI0@ X"~ 04 la.ytn/'0'6''()***:+{mmmm\^$If^`^gdn^$If^`^^$If^`^gd}_$Iflkdm $$Ifl0@ X"~ 04 la.:+;+<+E+F+k++||$If  !^ !lkd!$$Ifl0@ X"~ 04 la.++++++ ,t,u,v,w,x,y,z,,,,,,---.-/-0-2-O-P-Y-Z-g--------뿴돜릁{uoui{eh}_ he-CJ h[CJ h>CJ hTCJ hbRCJhc0JCJj#hcCJUjhcCJU h: CCJh>-h\vWh>-h\vWB*phhcB*phh$DhcB*CJphh$DhbB*CJphhc hS!CJ hcCJh[hc>*B*CJph%++ ,u,$Iflkd!$$Ifl0@ X"p04 la<u,v,w,x,z,,,,-ztnn$If !  !^ !^`lkdj"$$Ifl0@ X"p04 la<-------Q.R...Y/Z/zztnnnnnnn$If !  !^ !^`lkd#$$Ifl0@ X"p04 la< --....0.7.P.R.n..........Y/Z////>0?0a0b0c0p0q0011ܔ܈{wm`mXmhc0JCJj$hcCJUjhcCJUhchq~?hB*CJph hCJ h `CJ hTCJhKhc>*B*CJphhKh >*B*CJphhKh CJhKhcCJ hCJ he-CJ hbRCJ hcCJh[hc>*B*CJphh[h[>*B*CJph"Z///////H1I122223|s $IfgdbR  !^ !lkd]$$$Ifl0@ X"p04 la<$If 1-1G1}11111111122 2I2J2V222222222223*3+3Z3[3u3v3333333#6ľĚtttplhch?jhbRB*CJUphhbRB*CJphhq~?hB*CJph hCJhJMho0JCJhohoCJjhoCJU hoCJ h?CJh {6hbR0JCJhbRhbRCJjhbRCJU hbRCJ hcCJ he-CJ h>CJ)33333334O4|4||||$If !vkd%$$Ifl 0@ X"p04 la<yt + |4}445{6]7e88~~m~\^$If^`^gdq~?^$If^`^gd^$If^`^$IflkdR&$$Ifl0@ X"~ 04 la.#606}66667\7_7c7f7u7777 8*898d888888:.:::;l;m;;<<<<]=>x>y>|>>>Y?g?@@Ļzvh hs"cCJ^Jh CJ^JhvQCJ^Jh}_CJ^Jh[CJ^JhcCJ^Jhch4#hq~?hcCJhKh7CJhKhUCJhKh' XCJhKhdCJhKhcCJ h}_CJ hCJ hcCJ hCJ-8888889{99:m;;|nnnnn^$If^`^$If  !` !lkd&$$Ifl0@ X"~ 04 la. ;;;<]=>x>wwfU^$If^`^gds"c^$If^`^gd ^$If^`^gd}_$Ifpkd'$$Ifl0@ X"p064 la<x>y>z>{>|>>>>??{{qkeWW^$If^`^$If !  !`  !gd  !`pkd($$Ifl0@ X"p064 la< ??@@$Ifpkd($$Ifl0@ X"p064 la<@@@@@@@@A3Azttt$If ! !>^`>pkd?)$$Ifl0@ X"p064 la< @@@@AAoAtAAAA/B>B?CCCCCDDDDDE%E0E;EcEEEEEEEEEEEEF}uodooh4hnCJ^J hs"cCJh4CJ^Jh4h4CJ^J h>CJ h?CJh4h4CJ h4CJ hnCJh4hcCJ hcCJhyh?CJ^Jh}_CJ^JhCJ^Jh>CJ^JhCJ^Jh5CJ^JhcCJ^Jhch4#hfG'3A4A:AAB?CCzzzz^$If^`^$Ifpkd)$$Ifl0h@ X" 0 64 laCCCCCCDDDEEgF|vvvmmd $Ifgds"c $Ifgd4$If  !` !skdi*$$Ifl0h@ X" 0 64 la F F FF+F-F.F*B*CJphh[hc>*B*CJphh[h[>*B*CJph he-CJ h>CJ hHCJ hCJhShc)0JCJj+hShc)CJUhc)hc)CJ hc)CJjhc)CJU hcCJhU<hs"c0JCJhs"chs"cCJ hs"cCJjhs"cCJU h4CJ#gFhFFHHuIvIpJ$Iflkd+$$Ifl0 X"04 la<HHHHHIIuIJJpJqJrJtJ{J&K=KVKWKlKmKKKKKKKKLLLLLLMMMMMMM(ObOOPÿٹ墯ǔÏ劏ÂzrhqVCJ^JhNlCJ^JhcCJ^J hy5 hc5 hFaCJhc0JCJj-hcCJUjhcCJU h-"CJhXGhc h/?CJ h.aCJ hCJ he-CJ h>CJ hcCJ h8CJh[h[>*B*CJph,pJqJrJsJtJzJ{JJJ||$If  !^ !lkd,$$Ifl0 X"04 la<JJ KKKL$Iflkd(-$$Ifl0 X"04 la<LLLLLLM||$If  !^ !lkd.$$Ifl0 X"04 la<MMMMMAMM~tnn$If  !^  & F !` !lkd/$$Ifl0 X"04 la<MMMMMMMMMSNxrdd^$If^`^$If & F 8!>^`> !lkd/$$Ifl0 X"04 la< SNTNZNP6QQSTTTzzzzzzz^$If^`^$IfpkdI0$$Ifl0h@ X" 0 64 la PPPPPPPPPQ4Q5QkQqQQQQaRjRRRRRRSoS|STTTTTUU UUUUU幮ǥ嗏yoi hc)CJjhc)CJU hcCJhchyh kCJ^Jhs"cCJ^JhzCJ^J hs"cCJh4hNlCJh4hNlCJ^J h>CJh>CJ^JhNlCJ^J hNlCJhFaCJ^JhqVCJ^JhcCJ^JhkhZCJ^JhZCJ^J&TUUU U U/UsU|vv$If !  !^skd0$$Ifl0h@ X" 0 64 lasUtUUWWXX~Y $IfgdNl$Iflkdx1$$Ifl0 X"04 la<UUUVVVV5VSVVVVWWWWWWXXX}Y~YYYZxZyZZZZZZ{wqgqZgRghg0JCJj44hgCJUjhgCJU hgCJhc h/?CJ hFaCJh8>*B*CJphh[h8>*B*CJph h8CJ hcCJ he-CJ h>CJ hNlCJ hs"cCJ hLCJhShc)0JCJjhc)CJUj2hShc)CJU hc)CJhc)hc)CJ ~YYYYYYYzz$If !  !^lkd3$$Ifl0 X"04 la<YYZZZ[[\ $Ifgd8$Iflkd3$$Ifl0 X"04 la<ZZZZZZZ[[[\\\\\8];]A]K][]\]_]%^'^(^)^1^^^^^^^^___{aa5b6b7b9bbbÿzh B*CJ^Jphh$Dh B*CJ^Jphh!\CJ^Jh]:CJ^Jh-"CJ^JhcCJ^JhXG h~QCJhchy h/?CJ hFaCJh8>*B*CJphh[h8>*B*CJph h8CJ hcCJ hgCJ,\\\\\\\]||$If  !` !lkd4$$Ifl0 X"04 la<]]8]&^$Iflkd5$$Ifl0 X"04 la<&^'^(^)^0^1^V^^||$If  !^ !lkd'6$$Ifl0 X"04 la<^^^_$Iflkd6$$Ifl0 X"04 la<_______q`xrr$If & F 8!>^`> !lkdU7$$Ifl0 X"04 la<q`r`x`a7bbccddd ezzzzzzzzq $Ifgd<^$If^`^$Ifpkd7$$Ifl0@ X"~ 0 64 la. bbbcddJdTdbdddddddd e2eee3f4f5f7fdfffgghhiiiiii&j'jjjjjkk(kǿϷ睙煝{shnICJ^J hp3CJhhyhCJ^JhNlCJ^Jh$Dhc hcCJh<CJ^JhnCJ^Jhs"cCJ^JhE]DCJ^Jh/?CJ^JhFaCJ^Jh8*CJ^Jh~QCJ^JhcCJ^J h!\h!\5B*CJ^Jph- e e2eeezz^$If^`^$Ifpkd8$$Ifl0@ X"~ 0 64 la.eee3f$Ifskd*9$$Ifl0@ X"~ 0 64 la.3f4f5f7fcfdfyf0g$If !skd9$$Ifl0@ X"~ 0 64 la.0g1g7ggAhzi^$If^`^gd~Q^$If^`^$Ifpkd^:$$Ifl0@ X"~ 0 64 la.AhBhghi$Ifpkd:$$Ifl0@ X"~ 0 64 la.iiiiii/ii~xx$If ! !skd;$$Ifl0@ X"~ 0 64 la.iii'j$Ifpkd6<$$Ifl0@ X"~ 0 64 la.'j(jMjjjjjjjkklk$Ifpkd<$$Ifl0@ X"~ 0 64 la. (kjkkkmkokpkkk,ll1mHmUmWm%n&nnnnn0oWooo]p_p`p{pppqqqŶŪ~vpvpvpvldUhh+B*CJ^Jphh+CJ^Jhy h CJh CJ^Jh CJ^Jh B*CJ^Jphh B*CJ^JphhHB*CJ^Jphh+B*CJ^Jphhq~?h(kB*CJ^Jphhq~?hcB*CJ^Jphh~QCJ^JhchXGh$DhcCJ^Jh/?CJ^JhFaCJ^J lkmknkpkqkkkkyltnn$If & F 8!^` !pkd`=$$Ifl0@ X"~ 0 64 la.ylzlllUm&nnuudS^$If^`^gd ^$If^`^gdH^$If^`^$Ifvkd=$$Ifl0@ X"~ 0 64 la.yt nnn1o $Ifgd vkd>$$Ifl0@ X"~ 0 64 la.yt 1o2oWoo $Ifgd vkd5?$$Ifl0@ X"~ 0 64 la.yt ooo^p $Ifgd vkd?$$Ifl0@ X"~ 0 64 la.yt ^p_p`papzp{ppqqquke\\S $IfgdH $Ifgd+$If  !^  & F !  !`vkdu@$$Ifl0@ X"~ 0 64 la.yt qqrr5r6r7r\rrrrzt$IfskdA$$Ifl0@ X"p064 la< $Ifgd+ $IfgdH q4r5r6r\rrrrrrrrr0shsvswsyssstttMtttttttuvvvSwtwww6yʺ|t|ldhfCJ^JhnICJ^Jh/?CJ^JhFaCJ^JhKh7CJ^JhKhNOCJ^JhNOCJ^JhhCJ^Jhv3CJ^Jho~CJ^JhcCJ^Jhg h$Dhc h+UICJ h+CJh+CJ^JhhHB*CJ^JphhHhHCJ hHCJ&rrrrrrrrnhbb$If ! & F 8!>^`>  !^skdA$$Ifl0@ X"p064 la<rssksNtttvvwWyzzzzllll^$If^`^H$If^H`$IfpkdIB$$Ifl0@ X"$ 0< 64 la 6yUyWy}yyzzz{{{ {${&{,{J{K{L{q{{{{{||U}V}W}|} ~ ~ ~0~~~~~wxstuvxſſſŞhlh(tCJ h(tCJhlCJ^J hlCJhlhlCJh9FhNOCJhKhNOCJ hg CJ h9FCJh9Fh9FCJh9Fh(thg hq~?hc hcCJhcCJ^JhfCJ^Jh kCJ^J0WyXy}yy$IfskdB$$Ifl0@ X"$ 0< 64 layyzz$IfpkdxC$$Ifl0@ X"$ 0< 64 lazzz{$Ifpkd D$$Ifl0@ X"$ 0< 64 la{{{ {!{"{#{${%{&{'{({){*{+{,{ !pkdD$$Ifl0@ X"$ 0< 64 la,{K{L{a{{{{g|`F & F ^$If^`^gd9Fvkd7E$$Ifl0@ X"$ 0< 64 layt9F $Ifgd9F  !8^8gd9F & F 8!`gd9Fg|||V}W}|} ~ofQ ^$If^`^gdl $IfgdlvkdE$$Ifl0@ X"$ 0< 64 layt9F & F ^$If^`^gdl ~ ~0~~k ^$If^`^gdl $IfgdlvkdwF$$Ifl0@ X"$ 0< 64 laytl~~~wx:skkXXXX & F $Ifgdg  ^$If^`^gdl $Ifgdlvkd%G$$Ifl0@ X"$ 0< 64 laytlstuvwx׀uooo_oYY$If & F 8!` !vkdG$$Ifl0@ X"$ 0< 64 laytl h$If^hgd(t ׀؀R$IfpkdH$$Ifl0@ X"$ 0< 64 la-G\]iˁЁQRST\x6Kxxph`phCJ^Jh+UICJ^Jh|CJ^JhzYCJ^JhGkCJ^JhCJ^JhYCzCJ^JhFaCJ^Jhch(thfGhcCJ^J hRSsCJ hCJh0hGk0JCJjIh0hGkCJUhGkhGkCJjhGkCJU hcCJ h>CJ hGkCJ%RSTUVWXYZ[\wl & F 8!>^`> !0^`0pkd+J$$Ifl0@ X"$ 0< 64 la wxra^$If^`^gd|^$If^`^skdJ$$Ifl0@ X"$ 0< 64 la$If !u4}t} $Ifgd6 $IfgdYCz$IfskdZK$$Ifl0@ X"$ 0< 64 la @ABRSЅӅԅ +4BJPQUfɆ}}u}uu}}jhhCJ^JhzYCJ^JhYCzCJ^JhKh|CJ^JhKhYCzCJ^JhKhNOCJ^JhKhb4%CJ^JhKhGkCJ^JhKhk3CJ^Jhzh0JCJ^JjhCJU^Jh|CJ^JhFaCJ^Jh+UICJ^JhCJ^J)'_mK\_stu45679:<=?@BCIJKL־ֶֶ֣֌||||rlrarhK0JmHnHu h&R0Jjh&R0JUhIySjhIySUhchcCJ^Jh6h6B* CJ^JphI}h6h6CJ^JhnICJ^Jh|CJ^Jhk3CJ^Jh7CJ^JhzYCJ^JhYCzCJ^JhCJ^Jhzh0JCJ^JjhCJU^J&45689;<>?ABMNOv $$Ifa$$a$ !skdK$$Ifl0@ X"$ 0< 64 la LNOPQRijkhchIyS h&RCJ+h7h&R5CJ$OJQJmH nH sH tH  h&RCJ$h7h&RmH nH sH tH h&R OPQR^i~ppr$If^r` $$Ifa$qkdL$$Ifl40$`\ 04 lalf4$Ifijkzllr$If^r`kdlM$$Ifl4F<$ 0    4 lalf4 ![kd`N$$Ifl$$04 lal(/ =!"#$R% (/ =!"#$R% ? Ddg^  c jAF ?cid:image001.jpg@01CCD516.EBEDAA80R] x#ngj/HB9 DF1 x#ngj/HBJFIF``C    #%$""!&+7/&)4)!"0A149;>>>%.DIC;C  ;("(;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;"" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?tk&PwuT}+oe_ysMlI'w` Iڹ*[] ;bEm&:%'j5^x;F#?r~2ɪF;dPGF[:*^0.tvbz??+~E" $P]؞ RiDrQx#ğzR\]BDw[F9\w3.?vһjRJ?GW4Km,d<Ѡ1#sQ.^]啼۬Fd`i$mhwuw5İi8frKum5ͬ3f梾nj\֊2,C N@z45HfxB>]4+^߈kw{c{hg;< tmON楧Fz5ax\60M486W_j|ְ8vg='FʠcYGScr3tڟ.ݱj%oioyo}FCa?x}:ת+`5J66cv+iea  *}Ogx~t+nKݥsw#Xbg$t27tT$HsYkk2-i=17 bԀGG\t ⵤvǫF< G^JDDQ߀iQsZ;Iu<gOVn>)S,}p* >bFA2UQn{2tQBCZ7ƟSf׵_Tz5'RU1 nާ5i__̱sH{*湹]qSFw:-噾՜1cj=BWwnZKd] M//NfuxㅔZM6qFNjגCjW5V #ʖ韽NGn/5 _An(B(2u.F:RFζ43/<1wj)Ƨ=։ِO`9m=g7OFaM`$;d0#54X֧Nteu ᳌sW&xgؒw G d{d~UXs\īufݴ\J\<|<u%>Y qZ Z\E'Y$pZ[,.@k4 sh\A.%DUIS.cRH 2{^E/m2>P+~-X٬Pܭw41(|eai+Ckgc*鞵1=HѐUAQEO N%t-'I$&?·%ekg-صBE\ҧͪ O^^[ Xg6*B*PRBP Body Text Indent 2^`@V Q@ FollowedHyperlink>*B* HS@bH Body Text Indent 3 `^`HrH 1M| Balloon TextCJOJQJ^JaJD/D nHeading 1 Char5CJOJQJPK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3ڗP 1Pm \\9Mؓ2aD];Yt\[x]}Wr|]g- eW )6-rCSj id DЇAΜIqbJ#x꺃 6k#ASh&ʌt(Q%p%m&]caSl=X\P1Mh9MVdDAaVB[݈fJíP|8 քAV^f Hn- "d>znNJ ة>b&2vKyϼD:,AGm\nziÙ.uχYC6OMf3or$5NHT[XF64T,ќM0E)`#5XY`פ;%1U٥m;R>QD DcpU'&LE/pm%]8firS4d 7y\`JnίI R3U~7+׸#m qBiDi*L69mY&iHE=(K&N!V.KeLDĕ{D vEꦚdeNƟe(MN9ߜR6&3(a/DUz<{ˊYȳV)9Z[4^n5!J?Q3eBoCM m<.vpIYfZY_p[=al-Y}Nc͙ŋ4vfavl'SA8|*u{-ߟ0%M07%<ҍPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 +_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!Ptheme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK]  t *t  '|#&+-1#6@FHPUZb(kq6yLFJNTZadhlnqwz| > m WSw6 X j""$]%&/':++u,-Z/3|48;x>?@3ACgFpJJLMMSNTsU~YY\]&^^_q` ee3f0gAhii'jlkyln1oo^pqrrWyyz{,{g| ~~s׀Rw4OiGHIKLMOPQRSUVWXY[\]^_`bcefgijkmoprstuvxy{}~KM&: 3E<z$%.%>(b(p()))I****+Z+u+ >-><>>>?lCCCMNNxRRR\yyyR}}}~~CXXXXXXXXXXXXXXXXXX !8@0(  B S  ?w$$4$t$t$$$4 $t $ $ $4!$t!$!$!$4"$t"$"$"$4#$t#$#$#$4$$t$$$$$$4%$t%$%$%$4&$t&$&$&$4'$t'$'$'$4($t($($($4)$t)$)$l$4*$t*$*$*$4+$t+$+$+$4,$t,$,$,$4-$t-$-$-$4.$t.$.$.$4/$t/$/$/$40$t0$0$0$41$t1$1$1$42$t2$2$2$43$t3$3$3$44$t4$4$4$45$t5$5$5$46$t6$6$6$47%t7%7%7%48%t8%8%8%49%t9 %9 %4: %t: %: %:%4;%t;%;%;%4<%t< IIWWcgrr==GKUUcc^^gk--xx:::< <(<:<E<@@@vAvA~AACCCCJJLLLOOOPPPPRRRSSSS;U;UBUVVVbbbbbbbbbbccahahoh#i#i1i     ! "%#$&)'(*+,/-.0125346789:;<=>?@BACFDEGHJIKLMNOPRQSTVUWXYZ[]\^`_acbdgefhijmklnopqrsutv QVaellvv++EIPPbbppeiuu&&55{{:::<'<.<@<P<@@@}AAAACCCCJJL L LOOOPPPPRRRSSSSAUHUHUVVVbbbbbbbbcc(c(ckhyhyh-i;i;i   !"$%#&()'*+,./-0124536789:;<=>?@BACEFDGHJIKLMNOPRQSTVUWXYZ[]\^`_acbdfgehijlmknopqrsutv >m*urn:schemas-microsoft-com:office:smarttags PostalCode9v*urn:schemas-microsoft-com:office:smarttagsState8o*urn:schemas-microsoft-com:office:smarttagsCity:q*urn:schemas-microsoft-com:office:smarttagsStreet;r*urn:schemas-microsoft-com:office:smarttagsaddress=t*urn:schemas-microsoft-com:office:smarttags PlaceType=s*urn:schemas-microsoft-com:office:smarttags PlaceName9w*urn:schemas-microsoft-com:office:smarttagsplaceB?*urn:schemas-microsoft-com:office:smarttagscountry-region Pwvwtsrqwovmwvvwvwwvrqwovmwvwvrqwovmwovmwovmwvwtstrqwovmw?tws?st?wwstwsstswstw?twswstswstswtswstwstwstwsstrqwovmrqtwswtsN{-(q())))9****+v+w++==>>>L>>???@@MNN+NOORRnUzUVWwwPyyyy@}}~u5689;<>?ABL<<{YY+f9f689;<>?AB3333N{&&&&&&>(q())I***+v+u//// 0d000z6z6{6{6|6688;; >=>>?sBsBEEEEMN\ ]jjllll#s%s,s,stUuvwsxuxwx\yySz\zR}}}}}}}}~t566899;<>?ABLN{&&&&&&>(q())I***+v+u//// 0d000z6z6{6{6|6688;; >=>>?sBsBEEEEMN\ ]jjll#s%s,s,stUuvwsxuxwx\yySz\zR}}}}}}}}~t566899;<>?ABz4 /  P7i .v$hb'4M"h8,{Eg8 35: .4Q@L|CypB PZJymEN WNXCOz J[W6'Y Z"hA9\g 2H ^8< ga|64)%&b8<m\d&tjpfV g m'h$z(i"zj_D6ob.p$!Xv@A'x:dM^`Mo(.0^`0o(. ^`OJPJQJ^Jo(-^`OJQJ^Jo(hHop^p`OJQJo(hH@ ^@ `OJQJo(hH^`OJQJ^Jo(hHo^`OJQJo(hH^`OJQJo(hH^`OJQJ^Jo(hHoP^P`OJQJo(hH ^`OJPJQJ^Jo(-^`OJQJ^Jo(hHop^p`OJQJo(hH@ ^@ `OJQJo(hH^`OJQJ^Jo(hHo^`OJQJo(hH^`OJQJo(hH^`OJQJ^Jo(hHoP^P`OJQJo(hH808^8`0o(.^`.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L.^`o(.0^`0o(.0^`0o(.  ^ `o(.^`. L ^ `L.  ^ `.xx^x`.HLH^H`L.^`.^`.L^`L.hh^h`o(.^`o(.0^`0o(. 808^8`0o(.^`.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L. ^`OJPJQJ^Jo(-^`OJQJ^Jo(hHop^p`OJQJo(hH@ ^@ `OJQJo(hH^`OJQJ^Jo(hHo^`OJQJo(hH^`OJQJo(hH^`OJQJ^Jo(hHoP^P`OJQJo(hHM^`Mo(.hh^h`o(.^`o(.cMc^c`Mo(.  ^ `o(808^8`0o(.^`.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L.  ^ `o( ^`OJPJQJ^Jo(-^`OJQJ^Jo(hHop^p`OJQJo(hH@ ^@ `OJQJo(hH^`OJQJ^Jo(hHo^`OJQJo(hH^`OJQJo(hH^`OJQJ^Jo(hHoP^P`OJQJo(hH^`o(.0^`0o(.00^0`o(.^`o(.^`o(.  ^ `o(.M^`Mo(.^`o(.h88^8`OJQJo(hHh^`OJQJ^Jo(hHoh  ^ `OJQJo(hHh  ^ `OJQJo(hHhxx^x`OJQJ^Jo(hHohHH^H`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHCypBYXvJ[W2H ^)%&bZhA9\(i35:g8 gmEN PZJm'hM"h8jpfz46ozj.pb' gaWN.4Q@A'x$m\dP7i OBU        NIP,        N        b        &        BD        <                 )5Bj8q`+ D+5+flrY Z n vpC}_H*gUy k-"$Qo{ 5 S!#4#uu#%$b4%[&)c)8* ,Z,>-64/Qy/ 1v34Y5709^9> >>S>^>q~?h@: C%DE]D9FF^FkaFRGXG+UInITJfKKH`MbN6PvQbRdSIySqV\vW' XSwXkYzY}Y@NZ[!\f] `s"cb#deM7ff#hfhy=iGkNl5m;mn`oRSs(t`'uNx,yYCz1M|}~S~o~pfG6k3<,idU[1<Yz9k DgS7y]:/?p?cn7"5b+IJhq9tu% L:I%Z T(k>gQ.a|g`dttOZW&Rv~L9m78>4<\}AFabp3FHg?/fe-zn +~QNOoXrZh cdLT$Dg  Ef(8JFWZ4F68@P@UnknownG*Ax Times New Roman5Symbol3. *Cx Arial5. .[`)Tahoma?= *Cx Courier New;WingdingsA$BCambria Math"1hF!3!G1onBonB!24 3QHX ?dS2!xx CRAIG BROWN handwergerk                          Oh+'0p   , 8 DPX`h  CRAIG BROWNNormal handwergerk49Microsoft Office Word@2j&@:9@ Ǵ@r8Hon՜.+,D՜.+,, hp|   B  Title 8@ _PID_HLINKSAr}26#https://ows01.hireright.com/login/Vu3#mailto:documentation@hireright.com/?0(http://exclusions.oig.hhs.gov/home.html+9-http://www.aoa-net.org/}4*$http://www.ama-assn.org/amaprofiles+9'http://www.aoa-net.org/}4$$http://www.ama-assn.org/amaprofilesG!http://www.ecfmg.org/%4#http://www.americanboardortho.com/"7/https://www.abpd.org/Verification-Request.aspx^http://www.aboms.org/^http://www.aboms.org/+9http://www.aoa-net.org/O>https://www.deadiversion.usdoj.gov/webforms/validateLogin.jspE http://www.deanumber.com/*, http://www.drdata.org/)dhttp://www.state.oh.us/den)ghttp://www.state.oh.us/medL*L#cid:image001.jpg@01CCD516.EBEDAA80  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$)Root Entry FB9\H+Data N1Table{bWordDocumentTtSummaryInformation(DocumentSummaryInformation8CompObjy  F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q