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.