Practitioner Name definition
Examples of Practitioner Name in a sentence
I am providing the following details in order for a Care Insight Authorised “Lookup” User Account to be created for me: Position (e.g. General Practitioner) Name of organisation (e.g. Medical Centre) NZ medical registration number (e.g. NZMC) Contact email Contact phone I have read, understood, and agree to the aforementioned terms and conditions of being an Authorised User to “lookup” patient records via the national Care Insight network.
FOR THE PRACTITIONER: Practitioner Name Signature Federal Tax ID NPI Primary service address: FOR EGID: ▇▇▇▇ ▇.
To provide for the maintenance of high standards of ethical conduct and professional endeavor, EFT Universe and Energy Psychology Group (hereafter “EFT”) and _____________________ (Practitioner Name, hereafter “PRACTITIONER”), whose address is _________________________________________, enter into this AGREEMENT.
Superior Movement Physical Therapy, LLC Signature: >> Signature: Name: ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇ >> Printed Name: Title: Owner and CEO Date: >> Date: Practitioner Name: ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇ Business Name: Superior Movement Physical Therapy, LLC Business Address: P.O. Box 141, Grand Marais.
Date Person Making Query Name of Querying Entity Address City, State, Zip RE: [Practitioner Name] (License#: [License Number], State: [State], NPI: [NPI Number]) To Whom It May Concern: This letter is to respond to your request for primary source verification regarding the status of the above- referenced practitioner at [Hospital Name].
Signature: Date: Practitioner Name: Primary Specialty: Email: A photocopy of this document shall be as effective as the original when so presented.
I certify that my application meets the standards, as summarized in attached Practitioner Credentials section with respect to the following HWHN credentialed practice specialties: Group name: Practitioner Name: Attestation and Authorization for Release of Information I authorize Healthways WholeHealth Networks, Inc.
Practitioner Name: Case Number: Current status of legal action: Date of Filing: Date of Incident: I certify to the best of my knowledge that all information provided above is correct and complete.
I am providing the following details in order for a CareInsight Authorised “Lookup” User Account to be created for me: Position (e.g. General Practitioner) Name of organisation (e.g. Medical Centre) NZ medical registration number (e.g. NZMC) Contact email Contact phone I have read, understood, and agree to the aforementioned terms and conditions of being an Authorised User to “lookup” patient records via the national CareInsight network.
Signature: Date: Practitioner Name: Title or Designation (DC, LAc, GCFP, etc): A photocopy of this document shall be as effective as the original when so presented (Signature stamps are not acceptable).