Embedded Files
General Clipping
General Clipping
[Board Name]:
PASTE THE BOARD CERTIFICATION VERIFICATION
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Completed by [FIRST INITIAL LAST NAME]
Medpass Inactive
Medpass Inactive
Inactive Medpass
Verification is inactive on medpass
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Completed by [FIRST INITIAL LAST NAME]
Verified by Phone Clippings
Verified by Phone Clippings
(Board Name):
Contacted the (Board you contacted) at ___________ and verified the information listed below for (Enter providers/Providers name).
Provider:
Specialty:
Certification #:
Eligible Status:
Issue Date:
Expiration Date:
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Completed by [FIRST INITIAL LAST NAME]
American Board of Emergency Medicine:
American Board of Emergency Medicine:
Contacted the American Board of Emergency Medicine at 517.332.4800, extension 381 and verified the information listed below for "insert provider’s name".
Provider:
Eligible Status:
Issue Date:
Expiration Date:
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Completed by [FIRST INITIAL LAST NAME]
Not Certified Clippings
Not Certified Clippings
Using Online Search
Using Online Search
(Board Name):
*Unable to locate a record of the provider searching the (Insert name of board) online verification tool.
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Completed by [FIRST INITIAL LAST NAME]
Emailed Board
Emailed Board
*Received an email from (Insert name of board specialty) stating they are unable to locate a record of the provider in their system.
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Completed by [FIRST INITIAL LAST NAME]
Not Found verified via Phone
Not Found verified via Phone
*Contacted (Insert name of board specialty) at (Insert telephone number) and verified they are unable to locate a record of the provider by name, SSN or DOB in their system.
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Completed by [FIRST INITIAL LAST NAME]
Not Verified due to information provided not being for a Board Certifying Agency
Not Verified due to information provided not being for a Board Certifying Agency
Association/Membership
Association/Membership
*The (Enter Association/Membership Name) is not a board certifying agency. The (Enter Association/Membership Name) is a membership program for (Enter profession type. Example: pharmacy) professions. Members keep their membership active by completing continuing education hours.
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Completed by [FIRST INITIAL LAST NAME]
State Pharmacy License
State Pharmacy License
*The submitted board (Insert State Board) is not a board certifying agency. The information provided is for the provider's (Insert State) state pharmacy license.
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Completed by [FIRST INITIAL LAST NAME]
Certification Association
Certification Association
*The (Insert certification association name) is not a board certifying agency. We do not verify (Type of certification) Certifications.
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Completed by [FIRST INITIAL LAST NAME]
Eligible Providers
Eligible Providers
American Board of Emergency Medicine
American Board of Emergency Medicine
*American Board of Emergency Medicine will not verify a provider who is eligible without a signed release. Provider’s Eligible date is (Insert Date).
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Completed by [FIRST INITIAL LAST NAME]
Unable to Verify Eligible Applicants
Unable to Verify Eligible Applicants
*Unable to verify eligible applicants. Order will be reopened once the applicant is board certified. Provider's Eligible Date is (Insert Date).
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Completed by [FIRST INITIAL LAST NAME]
Provider is Board Certified with ABMS, but cannot be verified through AOA
Provider is Board Certified with ABMS, but cannot be verified through AOA
Unable to Verify the Certification with AOA, but the AOA profile does list that the provider is board certified through ABMS
Unable to Verify the Certification with AOA, but the AOA profile does list that the provider is board certified through ABMS
*Unable to locate a record of the provider's specialty in <insert specialty> searching the American Osteopathic <insert Board> online verification tool. The AOA profile lists the ABMS Certification with the <insert Board>, which can only be verified directly through ABMS.
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Completed by [FIRST INITIAL LAST NAME]
Eligible Status: Not Certified
Verified Status: Not Found
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