INFORMATION FOR COMPLETING APPLICATION FOR LOCUM TENES OR ...
• Physician Data Center Profile from the Federation of State Medical Boards (Form #1445) (FCVS) • Physician Profile Data Report from the American Medical Association (AMA), or American Osteopathic Association (AOA) • Malpractice Suits or Claims (Form #2829) and copies of malpractice suit, court documents with allegations ................
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