Naturopathic Physicians Statement Of Certification {3651}

3651 - NATUROPATHIC PHYSICIAN’S STATEMENT OF CERTIFICATION. This form is used by naturopathic physicians to confirm that they are properly licensed and agree to treat patients with Oregon on-the-job injuries in accordance with Oregon law. By completing and signing this form, the physician certifies that they are licensed either by the Oregon Board of Naturopathic Medicine or another licensing body and have reviewed the Naturopathic Physicians’ Handbook and accompanying materials. The form collects essential information including the physician’s license number, business contact details, and federal identification numbers if available. Once submitted to the Workers’ Compensation Division’s Policy Team, the physician will receive a confirmation notice acknowledging their certification. www.FormsWorkflow.com