Practitioner Documents

Document Type File Name
HSC/LAC CME Form
HSC/LAC Disclosures and Definitions.pdf
HSC/LAC HSC Release and Attestation
HSC/LAC HSC Release and Attestation - DocuSign Enabled Link
HSC/LAC HSC/LAC Application Form
HSC/LAC NMMB Applicant Oath
HSC/LAC NMMB Instructions for All Applicants
HSC/LAC NMMB Instructions if Applying Direct Through NMMB
HSC/LAC NMMB Instructions if Applying Using FCVS
HSC/LAC NMMB Instructions If Applying Using HSC
HSC/LAC NMMB Malpractice History Form
HSC/LAC Professional Practice Questions
HSC/LAC References List.docx
CA California Initial Credentialing Application
CA California Initial Credentialing Application PPQs
CA California Initial Credentialing Application_Release and Attestation
CA California Re-credentialing application.pdf
CA California Re-credentialing Application_PPQs.pdf
CA California_Initial_Credentialing_application_application.docx
CA California_Re-credentialing_application.docx
CA CPPA_Addendum_A.doc
CA CPPA_Addendum_B.doc
CO Colorado State Mandated Application Signature Pages - DocuSign Enabled link
CO Colorado State Mandated Application.pdf
CO Colorado State Mandated Application_Attestation.pdf
CO Colorado State Mandated Application_PPQs.pdf
CO Colorado State Mandated Application_Release.pdf
CO Colorado State Mandated Application_Supplemental A
CO Colorado State Mandated Application_Supplemental B
LA Louisiana Standardized Credentialing Application.pdf
LA Louisiana Standardized Credentialing Application_PPQs.pdf
LA Louisiana Standardized Credentialing Application_Release and Attestation.pdf
TX Texas Standardized Credentialing Application
WA Washington Practitioner Application and Release PDF version
WA Washington Practitioner Application_Word version
WA Washington Practitioner Release Form