Physicians//Document Checklist
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The following list of documents assists your representative while searching for and matching your qualifications and preferences with the best practice opportunity available. These documents are also utilized when submitting your credentials to our clients and when applying for hospital privileges and licensure.
- One photo copy of your current Curriculum Vitae (CV).
- One photo copy of your Medical School diploma.
- One photo copy of each of your Internship, Residency and Fellowship certificates.
- One photo copy of each of your Specialty Board certificates.
- One photo copy of your current state license card for each state in which you are licensed.
- One photo copy of your ECFMG (if applicable).
- One photo copy of your DEA license.
- One photo copy of each state controlled substance license (if applicable).
- One passport sized photo (preferred) and/or clear copy of your driver’s license (may be required for privileging and/or licensing).
- Three (3) references. You can download the Reference form in Word or Adobe Acrobat Reader format.
- Provider agreement (when placed).
- W-9 form (when placed).
Though not all documentation is required to begin the process, please
note that Linde Healthcare requires these documents before the start
of the assignment. If you have any questions about the information requested,
please call your representative at
1-800-588-4343.
