Registration Requirements

Applicant must provide corporate certificate number collected, and a copy of articles of incorporation and by-laws. If corporation is out of state, a copy of the form titled “Certificate of Authority to do Business in Washington” as on file with the Washington State Secretary of State's Office and copy of current by-laws. Copy of liability insurance policy.

Applicants must list all states where they do or did hold credentials. This list must also include when the applicant has applied for a credential, even if a credential was not granted. The jurisdiction where the applicant is or was credentialed must complete and submit the verification form (PDF). The jurisdiction must send the completed form directly to the department.

Each applicant must answer the personal data questions. If there is a positive answer to the professional liability claims history question, the applicant must send an explanation of the nature of the case, data and summary of care given, copies of the original complaint, and the settlement or final disposition. If a case is pending, applicant must indicate status.

Applicants must acknowledge that they will do criminal background checks on all healthcare providers before referring to a facility.