SECTION 310:2-15-2. Uniform application for credentialing of providers

(a)   The application described in OAC 310:002-15-2(b) is intended for use pursuant to Title 63 O.S. Supp. 1998, Section 1-106.2.

(b)   The uniform application for credentialing of providers requests the following:

(1)   personal information;

(2)   education, including medical, dental and professional schools;

(3)   training, including internships, residencies, fellowships and preceptorships;

(4)   professional licenses;

(5)   certifications and registrations;

(6)   academic appointments;

(7)   health care affiliations;

(8)   other professional work history;

(9)   current professional practice;

(10)   office billing information;

(11)   attestation;

(12)   copies of required documents; and

(13)   any additional information needed to answer all questions fully.

[Source: Added at 16 Ok Reg 901, eff 1-5-99 (emergency); Added at 16 Ok Reg 1389, eff 5-27-99; Amended at 17 Ok Reg 687, eff 12-16-99 (emergency); Amended at 17 Ok Reg 2034, eff 6-12-00]