FOR PRESENTATIONS, the below are required for your provider to be considered.
- Attached CV- Scope of practice on CV job history section. Explain gaps on CV (30-day gaps. Provider Phone Number, Email and Home Address must be on the presentation CV. If your agency is unable to comply with this requirement, then it must be added in the presentation notes section.
- NPI#
- FULL legal name (first, middle, last)
- Board Certification(s)- If board eligible (List ifis Candidate within 5-years of residency?)
- Certifications
- Procedures: (For Inpatient Services)
- Available to Start
- Shift Availability
- Willing to work day/night/weekends
- License status of state presenting? Active or In Process (Must provide proof application) or Apply upon Approval
- Other Active State Licence(s)
- DEA(s) & their status
- Malpractice/Disciplinary: (Must provide detailed explanation with presentation)
- Call Interview Availability for the next 10 business days
- Phone Number
- Bill Rate
If Applicable:
- Airfare, Lodging and Rental
- Please indicate and affirm whether or not that you, the agency of candidate, are willing to obtain a state-specific DEA for this assignment.
- Please indicate and affirm whether or not that you, the agency and the candidate, agree not to change the DEA address during the duration of candidate’s time privileged with facility through CommonSpirit.
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