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Michigan Voluntary Medical Background Form

Category:
Michigan Statewide - Safe Delivery of Newborn
State:
Michigan
Control #:
MI-DHS-Pub-867-0
Format:
Word
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Description

Voluntary Medical Background Form The Michigan Voluntary Medical Background Form is a document required by the state of Michigan for certain health care professionals who are applying for a license to practice in the state. This form is used to collect information on the applicant's medical background, including any prior health care-related convictions, professional discipline, and hospital privileges. There are three types of Michigan Voluntary Medical Background Forms: the Standard Form, the Enhanced Form, and the Michigan Mental Health Professional Disclosure Form. The Standard Form requires applicants to provide information on prior convictions, professional discipline, hospital privileges, and other relevant health care-related information. The Enhanced Form requires additional information including details about any medical malpractice lawsuits, disciplinary actions related to substance abuse, and any other health care-related matters. The Michigan Mental Health Professional Disclosure Form is specific to mental health professionals and requires additional information on any prior convictions, professional discipline, or hospital privileges related to mental health.

The Michigan Voluntary Medical Background Form is a document required by the state of Michigan for certain health care professionals who are applying for a license to practice in the state. This form is used to collect information on the applicant's medical background, including any prior health care-related convictions, professional discipline, and hospital privileges. There are three types of Michigan Voluntary Medical Background Forms: the Standard Form, the Enhanced Form, and the Michigan Mental Health Professional Disclosure Form. The Standard Form requires applicants to provide information on prior convictions, professional discipline, hospital privileges, and other relevant health care-related information. The Enhanced Form requires additional information including details about any medical malpractice lawsuits, disciplinary actions related to substance abuse, and any other health care-related matters. The Michigan Mental Health Professional Disclosure Form is specific to mental health professionals and requires additional information on any prior convictions, professional discipline, or hospital privileges related to mental health.

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Michigan Voluntary Medical Background Form
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