• Safe and secure

  • Quick and easy

  • web-based solution

  • 24/7 Customer Service

Rate form

4.1 Statisfied

268 votes

To Fill In Physician Certification Form Azdhs , Follow the Steps Below:

Create your Physician Certification Form Azdhs online is easy and straightforward by using CocoSign . You can simply get the form here and then write down the details in the fillable fields. Follow the instructions given below to complete the document.

Fill out the customizable sections

Customize the form using our tool

Fax the completed form

  1. Look into the right document that you need.
  2. Press the "Get Form" icon to get your file.
  3. Check the whole form to know what you need to key in.
  4. Enter the information in the free-to-edit parts.
  5. Double check the important information to make sure they are correct.
  6. Click on the Sign Tool to design your own online signature.
  7. Drag your signature at the end of the form and press the "Done" button.
  8. Now your form is ready to print, download, and share.
  9. If you have any doubts regarding this, don't hesitate to contact our support team.

With the help of CocoSign's eSignature solution , you are able to get your document edited, signed, and downloaded right away. All you have to do is to follow the above process.

Thousands of companies love CocoSign

Create this form in 5 minutes or less
Fill & Sign the Form

Hand-in-Hand Teaching Guide to key in Physician Certification Form Azdhs

youtube video

Physician Certification Form Azdhs Demand Assistance

okay good morning everyone we're going.to go ahead and get started thank you so.much for taking time out of your busy.day to attend this webinar we are.pleased to have you to attend our.webinar for instructions on how to.submit an electronic renewal application.for a third year we want to let everyone.know that you have been needed upon.entry of the webinar because we will be.recording it to place on our website as.a reference guide for all renewing.participants you will also be able to.ask any questions in the chat box on the.right hands box on your screen and we.will answer the questions at the end of.the webinar we hosted two additional.webinars last week like I mentioned.earlier we will be posting the.recordings and the powerpoints on our.website and we will be also emailing.them to everyone now I'm going to turn.the time over to Anna Rosetti for our.presentation good morning everyone my.name is Anna Rosetti MD section manager.for workforce for the Arizona Department.of Health Services Bureau of women's and.children's health I'd like to welcome.you all to today's webinar we're going.to cover the state law payment program.electronic application system source.target audience for today's webinar our.state law grants program participants.whose initial contracts are ending.between April 1 of 2019 and March 31 of.2020 for our policy all of these.participants that are renewing for year.3 can apply during an open renewal.period which will begin on March 1 of.this year through April 1 of 2019 so.this is the only time that you will be.able to submit a year 3 renewal.application this year we are not going.to accept any paper applications because.we are fully electronic with our.application system so we are requiring.everyone who is renewing for year 3 to.apply through the state lower payment.program portal some of the important.notes I want to mention today is.your service sites have to be registered.in the state more payment program portal.before providers can apply or reapply so.right now our site registration cycle is.open and it's open until February 28th.of 2019 so please make sure to check.with your site administrators to confirm.that your site has registered you can.also email us and we can confirm if your.site has registered again this is very.important because if your site have not.registered you're not going to be able.to see that site in a drop-down menu for.you to be able to submit your.application online so make sure that you.do this before you you access the portal.making sure that your site.administrators have confirmed that your.site is in fact registered in our portal.so last year we launched this electronic.system we initially launched launched.the electronic application for new.providers submitting their initial.application the portal and what's.improved as you know a little help on.through the paper-based application.system that's a real outdated system.it's very cumbersome if you recall our.electronic system where our goal is to.make the application process of.paperless process providers last two.years ago when you applied for your.initial application to the state loan.payment program you all recall that you.have you were responsible submit.site-specific documents from the.employer and those documents are the.sliding fee scale table the policy the.signage evidence of a hips so for this.particular fist on ik system submission.you are not going to be responsible for.those documents anymore that's the.reason why sites have to register in a.portal and part of their registration.process is to submit all of the relevant.documentation for this site so you're.not going to be able to or you're not.required to actually submit these.documents as part of your application.incomplete applications due to missing.or interests incorrect site-specific.documents were actually very common when.we were operating the paper-based system.and our goal is to eliminate or minimize.incomplete applications and also our.electronic system is designed to screen.in eligible applicants obviously you all.are here to reallocate applicants and.hopefully you continue to be eligible.for the program.and be able to submit successfully in.their portal so this is just to.emphasize who can apply for the for the.state loan payment program there's not.been a change to eligibility.requirements in terms of specific.provider types for those of you who.applied in 2016 or I'm sorry 2017 and.your contracts are obviously near.expiring and you know the program.expanded in 2015 and as a result we.added specific types of providers such.as mental health providers pharmacists.we have geriatric physicians and.psychiatrists there's not been a change.to our eligibility provider type so if.you have you know friends or coworkers.who are interested to apply please make.sure to let them know that they can.apply during an open application cycle.and our new provider application cycle.is going to open in April of this year.these are just additional eligibility.requirements for providers you of course.have already met this requirement being.that your current participants of the.program but again I want to emphasize.that you have to have a respect or a.current employment either full time or.half time status as an eligible site.providing outpatient primary care.services whether expansion we were able.to allow inpatient services only if.you're a provider working in a critical.access hospital you can apply or.continue to qualify for the state loan.payment program if you're working in a.critical access hospital in conjunction.with providing outpatient services as.the high school affiliate.roll health clinic and of course in.order to qualify for year three for all.of those who are renewing you have to.have qualifying loans that are still.owed and you cannot have any current.other than the state more payment.program obligation or and satisfaction.with any entity so for site eligibility.requirements hopefully you all stayed.with approved specs if you're no longer.or you're planning to transfer to.another site make sure that your site.for the purpose of year three renewal is.eligible and the eligible requirements.are on your screen it's half size has to.be public or private nonprofit the rural.private practice sites your sites have.to be located in the tips of specific to.your discipline for pharmacists.pharmacists have to meet a primary care.HIPAA for rural private practice sites.you have to be in a rural area if your.site is not a HIPAA you have to meet the.state hip so that as the state.designation of an arizona medically.underserved area has to have assignments.with access medicare and a qualifying.health plans available in your area and.also implement a sliding fee scale.except of course if your site is a free.clinic or a state prison so what your.responsibilities are is to understand.our program requirements in the online.application system there is a provider.reference guide that's available online.that you can find on that link I know.that's really hard but if you have a.copy of the webinar material so be able.to click on this link and you can get.access to this PDF document this is also.this also lives on our website under the.apply for repayment tab just scroll down.and you will see this guide on there.complete your application online.including uploading all supporting.documents that are required and also.follow up with your site administrator.which is very very very important I.can't emphasize this enough about your.application your part of the process for.cited minute.Raiders is to verify your employment.with them and also provide additional.eligibility verification so there are.two things that I'm asking you all to do.one is to follow up with your 7.administrator to make sure that their.site the site that you're in is.registered in our portal and then second.once you you initiate your application.the portal you will be able to you'll.see that the site administrator has on.the which I will also cover later on is.that the status of spending in terms of.employment verification process and what.you're going to do is to followup with.your site administrator to make sure.that they complete the provider or the.employment verification process not.until then can you actually submit your.application fully in the portal so I'm.going to go ahead and do the step by.step instructions on how to navigate the.portal so what I would like you to do is.to approach the portal as if you are.going to actually go back to this.PowerPoint okay what I'd like you to do.is to approach the portal as if you're a.new applicant to the portal I know that.you have all submitted your paper.application you all have submitted your.supporting documentation and we have.them in paper copies we have a physical.file of everything that you submitted.however in order for you to be to be.included in their electronic system we.need to capture information on there as.well as all of the documents that you.will be providing at this time so you're.going to approach the portal as if.you're an applicant to the to the state.loan payment program for the first time.ok so so they login the URL is provided.here on this screen this is also the.link is also on our website under the.apply for a payment tab if you scroll.down on that page you will see a click.here button that is where you click to.login to the portal once you log into.the portal you will see this page and of.course you don't have an.count in the system you're going to have.to create an account the expense button.no accounts for 81 once you're there.then it will bring you to this page and.because the portal is used by both the.side administrators and the obligated.providers you obviously have to identify.yourself and here you'll click obligated.providers once you click on that it will.be this this screen will be displayed.and where you're going to enter your.first name your last name your phone.number in your email and then create.your password and then register once you.click click register there's an email.notification that gets generated to your.email account you'll have to retrieve.that email and that email is is a direct.link to the portal which you're going to.click and then it will bring you to this.screen again where you're going to type.in your email address that you just.provided as well as the password and.then once you click log in you'll be.brought to this landing page so the.landing pages you can see there's.different things that you can do when.you get to the landing page because this.is the page that everyone sees whether.you're new applicant to the program.whether you're renewing applicants or.whether you're an applicant who is.reapplying maybe you have not you were.denied last time and you're reapplying.so this is the landing page that.everyone sees now click on so on I want.to show you where you're going to find.the so you can see on the middle of the.screen you'll see all of the initiated.applications so once you hit the renewal.application that initiated your.application and let's just say you have.to leave you didn't finish your.applications you save this you're going.to see any initiated application in the.middle of the screen where you view.where you can view the pending.applications and then if for example you.were successful in completing your.application and submitting it and you.will see this application on the bottom.of the screen so if you when you click.renewal application then you will be.asked to enter.your renewal application code so in the.middle of February you will be sent.Ashley and I will send you your renewal.application code and that is the code.that you're going to enter on here so if.you do not or thinking of mid-february.please please check with us or confirm.with us if you didn't receive anything.because we're thinking this figure will.be able to send everything our the exit.codes to everybody if you don't get it.please check your junk mail as well or.spam spam mails because sometimes it a.just mail go to your spam or junk mail.so make sure you check them to check.check it first there and if you don't.see it then follow up with us once you.enter your renewal application code here.click continue and then it will you will.be then brought to the provider.application screen which before I go.there I want to cover what sections you.need to complete as part of your.provider application so there are nine.sections that you need to complete the.first section is related to your.personal and discipline information then.it goes to the education license.information and then your past and.present commitment service to under.serve your qualifying Alone's which is.obviously this you need to update your.qualifying loan section because because.what we're trying to find is whether or.not you're trying to qualify your.existing loans because maybe you still.have balances on those loans or also and.or adding new loans so you're going to.update section five as accurately as.possible.employers employer service site.information and all of the supporting.documents will have to be uploaded in.the upload section and then there's a.section on certification and then the.final section is the checklist.verification which basically allows you.to go through all the supporting.documents check the boxes and make sure.that you've actually uploaded everything.the.commence to prepare it's important that.you have the documents ready to for.upload so that you'll have a more.seamless application process so the.required documentation we're going to.require us well submit to w94 you've.already submitted this two years ago.when you applied for your initial.application if your address has changed.since the last time you submitted an.application to a DHS that we did not.capture anywhere in your in any of your.contract amendments then you are.required to submit a new substitute w-9.form copy of the registration.confirmation email from the arizona.procurement portal so this is a new.system if you recall we had procure AZ.and last time when you applied for your.initial application our system has.changed it's now Arizona procurement.portal I'm going to show you later on.what it looks like so that you'll have.you familiarize yourself with what it is.hopefully what we were told is that all.vendors who were registered in procure.AZ their information should have.transferred over to this new system.which is the Arizona procurement portal.you should have received an email asking.you to either create an account in a PP.or update your account in a PP if you.didn't do that please make sure you do.that before you initiate your.application so the importance of the a.PP registration is that this is the.information or anything that you enter.in this portal is the information we use.for example when we're mailing your tax.form because of course you're funding.the funding that you get from slurp it.are tax exempt so we will mail your tax.form in the address that you entered in.the AP P we also any correspondence that.we have to do we use the address that.you listed in.a pee-pee and also in recreating your.contract or restore your renewal.contract we will use your information.that you entered in a PC so make sure.that you have an updated information.there and if you have issues there's a.help desk that you can call and ask for.guidance so birth certificate u.s..passport you all submitted this last.time again we were we are asking you to.submit everything as if you're.submitting for the first time or.applying for the first time in the state.or favorite program and then all the.other necessary documents are listed.here on item 10 I want to spell wanna be.more specific in terms of what we're.requiring for the food for the contract.if you submitted your contract before.and in your contract let's say your.current contract you're submitting your.current contract for the purpose of this.lerk renewal your contract has to.include specific things and those are.just things that by policy we need to.check one of them is your full time or.your half time hours depending on the.your service our participation if you're.a full time participant to the program.and qualifying for that for year three.then your contract has to state that.you're a full-time employee working at.least 40 hours per week if you're a.half-time participant and you want to.apply for a continue with a half-time.status then your contract has to stay.half-time at least 20 hours per week.your start date has to be in your.contract and the name and address of.site of your site has to be in the.contract so check your contract make.sure that all of these elements are.there if they're not in your contract we.will ask for an amendment in lieu of the.contract you may request or submit an.employment letter and the employment.letter has to be on your company's.letterhead has to have specific.information that I just met.and also have to have a contact person.of the person the designee for the.employer if it's not the CEO you have to.submit a copy of your most recent.billing statement for each qualifying.loan so for example if you have existing.approved loans let's say you have.navient.and you also qualified Great Lakes and.you're going to qualify those same loans.we will ask for the most recent billing.statement for those loans documentation.from the lender that the loans were used.solely for education their reasonable.living expenses and types of documents.you can submit or disbursement reports.national student loan database age.summary report and other documentation.so this said we're not asking for a.written letter from the lender we're.asking for any type of documentation.that indicates that you were attending.school when those loans were dispersed.to you if your loans were consolidated.since the time that we approved those.loans and if they're not captured in a.contract amendment then those loans.consolidated loans have to have itemized.itemized breakdown of the consolidated.loans that show all of the loans that.were consolidated and all those loans.have to only be educational loan your.educational loan so make sure that if.your loans were consolidated submit a.supporting document that shows the.itemized breakdown of the consolidated.loan some additional documents that we.will require you will you will be scored.your application will be scored against.others and one of the things that we.score you on is is your residency proof.of residency so if you have been.residing in Arizona for the past twelve.months then you're going to show.evidence of that I will cover in more.details what that means and then.evidence of service to the medically.underserved area it does not really it's.not needed for this particular.application because you're a renewing.applicant so you can you're not you're.not necessarily required to submit any.evidence of service.the medically underserved area even.though you can report your experience to.serving the medically underserved area.in this section of the application okay.so I'm going to before I cover this I'm.going to show you the step-by-step guide.for the provider for submitting your.application in the portal so this is a.landing page so if you click on the.renewal application then you can of.course get started with your with your.application but I created one just for.just for the purpose of this demo so.because I've already created one that I.see it here as a pending application all.I need to do is to resume my application.and then it will the first section is.the personal and discipline section of.the application so all of the tabs that.I mentioned earlier the different.sections you can find on the top at the.top of the screen these are all the.sections that you're going to going to.have to navigate through here under.personal discipline information is.basically you can you if you recall the.paper-based applications it's exactly.this this application except that now.you're filling them filling the sections.or their fields electronically so make.sure that when you're filling out each.section of the application you're you're.filling them out as completely as.accurately as possible so I'm going to.save and continue and then the second.section is your education and license.information this is the section where it.captures your undergraduate information.your graduate information may be post.graduate if applicable and then your.licensing information okay again all of.the fields are ready Priestly prefilled.for the purpose of this demo but I just.want to make sure.that you understand that if you there.are certain fields here that are.required and so pay attention to flags.they will be in red font if if if you.leave certain required fields blank it.will give you a flag is where you can't.continue until you provide your.information on those fields so make sure.again they will be in red font so make.sure you pay attention to those save and.continue this is a page where it's asked.you for your commitment past and present.so any any time you answer yes to any of.these questions will render you.ineligible for the program so these are.federal requirements you cannot have any.outlet you know any default or.delinquency season any of your service.commitment or financial commitments so.for example if I answer yes to this.question on tax liability it will flag.you that you're not eligible to apply.for the program so not not that I'm.encouraging you to say no to any of this.you have to be truthful obviously with.your responses but I'm just letting you.know and being upfront without.information in that if you defaulted on.any of these things or had delinquencies.on your taxes you will not be able to.eligible for the program oh okay so now.this is the section where you're going.to indicate your service or your.experience in serving the medically.underserved if you were a new applicant.to the program you will be scored on on.this mira see the number of experience.that you've had.serving the medically underserved but.because you're not a new applicant you.can simply fill out the information here.and move on so again the the sections.already prefilled so I'm going to save.and continue okay so this is a.qualifying loan section and basically.this is a section where you're going to.tell us who your lenders are and the.the loan details for each of those.lenders so for example you only have one.lender and let's just say it's fedloan.servicing you provide the current.servicers name the loan accounting for.number the purpose of the loan cannot be.can be education for educational.purposes only sorry your lender phone.number payment address so a lot of our.providers still provide the address the.general mailing address and not the.payments address and then we have to go.back to them and say hey can you give me.the payment address please so whatever.payment address you're enter here is the.information that you're we're going to.need or we're going to include in your.contract if you provide us with a.general mailing address and we didn't.capture that when we were developing the.contract then chances are your payment.will go to that general mailing address.and chances are it's going to be lost.somewhere and there's going to be delay.in posing that payment to your account.so make sure that the payments address.is provided in this field and then the.city state zip code original lender may.be original lender is I don't know US.Department of Education I'm just making.that up the total balance of your loan.and then as of today or yeah and then.the percentage of quarterly loan.repayment disbursement this is something.that you're going to tell us how we're.going to pay this lender what percentage.of your quarterly disbursement is.allocated to this lender so if this is.the only lender that you have then you.can of course assign a hundred percent.of your quarterly loan disbursement to.this lender but if you're if you have.say three lenders then you're going to.add a loan servicer to here and then say.another loan servicer so you have three.lenders you want to qualify and let's.just say fed loan navient.and then your search service service say.I don't know a private loan of Wells.Fargo or something then your you can.assign.your quarterly disbursement in a way.that totals 100% so this could be maybe.your Fred loan account has the highest.interest rate maybe that has a 6.8.percent interest rate and you want to.tackle that first and you want to say.okay well 50% of my quarterly.disbursement goes to this account and.then maybe 25 25 to the other two.lenders so you can assign whatever.percentage funding to each of those.lenders that you're reporting on this.section now every time you reporter.lenders or for example fedloan servicing.you have to tell us the details of those.loans so with that if you don't if you.leave this blank written it so when you.when you get to the screen the loan.details will just be hiding so hiding it.in the back you know on the bottom of.the loan servicer section so you have to.click the down downward arrow to display.the actual fields and then you're going.to tell us the difference the details of.those loans so for example on this one.let's say you have two accounts within.said loan and let's say you have direct.subsidized loans and then you have.direct unsubsidized loan you're going to.then provide a loan type of direct.subsidized and then you can add click.here to add another loan type and then.that's where you'll enter direct.unsubsidized that's how you're going to.fill out this section I know a lot of.the providers were confused last time so.we want to make sure that you know.you're you're clear on how to fill out.this page because it's not going to let.you continue unless you provide a.specific information about your loans so.again I want to emphasize if you're.reporting a lender you have to provide.us the loan details and if there's five.accounts in that low in that loan that.you're trying to qualify then you're.going to have to provide five different.loan details for the purpose of this.demo obviously.I added loan service or - I'm not going.to fill out this information and loan.service or treat.three you can delete it any time if you.if you for example click on that button.and you didn't intend to you can just.delete that and it will go away and then.I'll delete this as well okay so I'm.sure okay and then all right so I think.I deleted everything all right so now I.can save and continue actually let me go.back to that again there is a link here.so there is an error message or a pop up.message that comes up and it says please.update this section with your current.loan information the updated information.must be consistent with your current.billing statements and relevant loan.documents okay and it's telling you that.you need to upload that those specific.documents in the supporting documents.section so there is a link here.instructions now to complete this.section if you if you get confused.whatsoever we try our best to make this.section as user-friendly as possible but.it's still confusing to people so here.is the step by step or kind of a more.detailed information and how to fill out.that form or that section so again you.have access to that in your portal.statement continue this is a section.where you're going to ask to select your.employer name the site administrator and.the site so for the purpose of this demo.I selected Arizona Department of Health.Services and now I'm going to select my.site so I'm going to select my name the.site admin so if you don't know your.site as administrators name let's say.you think of.the site administrator obviously your.facility but it's not in a drop-down.menu just contact us and we can tell you.because sometimes they assign a.different point of contact for the site.so it may be it may be different from.from the practice administrator that you.know is should be responsible for it for.this employment verification if you.don't see that name in the drop down.menu contact us and we can tell you so.I'm going to select my name as the site.administrator and I'm responsible for.two sites so I'm going to select site.one okay and then you have to add that.site Oh something went wrong hurt you.okay so it's already added let me just.here let me just delete these and then.I'm going to do it again site one add.site.all right so now I've added my site and.I'm going to be working at site one so.you can see here that there is an.incomplete validation from the site.admin so this is the time when you see.this and it's still suspending that.means the site administrator has been.verified so an email notice is sent out.to the site an insulator at site one and.that site administrator is required to.verify your employment at that site and.also complete the additional.verification process so if you see this.pending that just means that your site.administrator has been completed the.verification process however even if.that's the case you can still continue.with your application and it will give.you this message and it says application.final submission can be performed only.after the site admin completes all the.verification process so again like I.mentioned earlier your site.administrator has to complete the.employment verification process in order.for for you to be able to submit your.application okay so if if your site.administrator did not complete this.process and it's still pending you are.not able to your you will not be able to.move forward with submitting your.application at all so make sure you.you follow up with your site.administrators and make sure that let.them know that they have to verify your.employment as soon as possible so you.can submit your application so remember.that the absolute deadline for.submitting application is April 1st.certainly last year we have had some.issues with site administrators not.verifying employment and therefore those.providers were not able to have an.initiated application it's just a matter.of them clicking the submit button but.they can't submit it because employment.the employment verification is not being.completed and therefore there are.certain couple providers who were able.to who are not able to submit by the.deadline and they missed basically that.opportunity so make sure the absolute.deadline is April 1st to submit your.renewal renewal application start your.application early follow up with your.site administrator make sure they.complete that process as fun as possible.and there and then you can submit your.application so this is the certification.page and it's basically the same exact.format as what you saw before in the.paper application it's basically asking.you to certify that you meet all of the.requirements of your program which is.very similar it's the same exact.language that you that you suffering.display their paper-based application so.you have to check these boxes to certify.that yes you in fact still meet these.requirements and then there's certain.authorizations that we're asking you to.office obviously read them and then.consent for us through to release either.your information for us to be able to.complete your application or application.review and then once you've initialed.all of these boxes and checked all of.the boxes on top save and continue ok so.here you get a pop-up message saying you.may upload all the required documents or.reuse existing documents listed so if.you applied through the photo when you.first submitted your application on if.you know two years ago all of the.documents that you've submitted through.the portal should be here but since your.since this is the first time.using your portal there's not going to.be any you can't reuse any of the.documents because we didn't have you.submit your initial application through.the portal last time but these are the.sections that you're going to navigate.through in submitting your documentation.so the first section is the application.certification page which you are see you.can see on the screen and if you recall.last time you submitted using the paper.application there is a section where.you're going to sign and notarized this.is this section we cannot this is.something that they written in their.policy and therefore we're still.required to collect the notary so in.order for you to submit the notarized.section all you need to do is download.the documents for notarization by.clicking this box initial application.certification print for signature and.notary once you click that then you can.open it and view the actual application.and once you view it you'll see this is.the exact same application that you.filled out two years ago except that now.it's prefilled with the information you.just entered so what you're going to do.is to print this document and the final.portion of this is this section where.all that's not this section sorry this.section where it says notary required so.print this entire documentation bring it.to the notary sign it and then once it's.completed then you scan it and and.upload it back in the system in order to.upload it you just click on view.documents continue to upload so.obviously there are some files here that.that were that were uploaded previously.so the next time you renew your contract.with us and renewing through the portal.you'll see all of the documents that you.that you submitted the next time you.apply but for right now when you when.you go into the portal obviously we're.not going to see anything so this is.where you're going to click to upload.your document so I'm going to try to.upload something.it wasn't over this one okay go to your.dress go to the newel mother okay so you.have to click Save in order to save that.file and here is selling that you have.successfully uploaded one file hit okay.and then now you go to procurement so.you have to navigate through every.single section of this upload section.basically so all of these sections have.specific documents that are required for.you to submit so here when you click on.procurement you'll see that we.identified all of the documents that you.need to upload so something to w-9 form.for the purpose of your year 3 renewal.you're not going to be required to.submit this form unless there's been a.change to your address and then your.procurements portable registration.confirmation you have to show or submit.evidence that you've been registered or.your register into a pp so those are the.two documents that you're going to.upload in this section so the bubbles.that you see here opposites each section.itself it basically indicates the number.of files that you've uploaded so here in.the procurement there are two files that.were uploaded if you view us or two.files here that's how you you can tell.that there were files uploaded.previously but for the fruit for the.year 3 renewal for all of you you'll see.0 on here and let you upload a file.personal information again this these.are the information we will collect.again to capture them in the electronic.system your birth certificate social.security card current driver's license.and your current TV license and.educational search.kiss your Arizona medical license.undergraduate graduate and if you did a.postgraduate degree also upload your.diploma a lot of people still ask us why.are we required to submit our degree or.undergraduate diploma the reason it's.not it's not because we're just wanting.to see it it's because it's in their.policy so even though you know it.doesn't seem to make sense like all of.you obviously have a higher education.but for the purpose of the statement.parent program application we are.required to collect that information so.make sure that you upload your your.under graduate diploma your graduate and.again post graduate if applicable your.board certification or acceptance letter.from the examining Authority and then.your state or national certification and.then employment verification documents.this is again telling you what documents.to be uploaded you can either upload an.executed employment contract that.includes all of the things that I.mentioned earlier and just to emphasize.your if your qualifying at the full time.participants your employment contract.has to state that you are working full.time at least 40 hours per week if.you're a half applicant then your.employment contract has to state you're.a half time employee employer or I'm.sorry employment for at least 20 hours.per week your start date and then the.name and address of the service site if.you're if you are submitting the.employment letter then all of those.elements again have to be included in.the letter if you are a provider working.at multiple sites the letter also has to.state the estimated number of hours that.you spend at each site and the reason.why is because we need to identify.whether you're working if you have a.primary site that you you are working at.and primary site is defined for the.purpose of the statement payment program.as a site where you work at least 20.hours per week which is half of your.full-time hours so if you're a half.times participant then at least 50 hours.of your time are spent at that facility.in order for.that site to be considered a primary.site and this is important because when.we do the scoring and if you have a.primary site the primary site score is.taken into consideration for the score.for scoring purposes and if that primary.site as the highest types of scores and.that's high if the score will be will be.used for the scoring purposes loan.documents again it tells you all of the.things that you need to upload a part of.this section we our most recent billing.statement for each qualifying.educational loan so please make sure if.your reporting that's a three in quality.in the qualifying loan section that you.have three billing statements uploaded.here because what we're finding is that.you know our providers they think that.they submitted something oh yeah I.submitted you know all of my recent.billing statement but in fact they.didn't so make sure that you know the.billing statement corresponds to the the.laws that you reported on the qualifying.loan section because again two solid.eight in loans we will ask for an.updated or itemized breakdown of the.consolidated loan so if you just.recently consolidated your loans and.it's not captured in our amendment in.the in any of the state or in program.amendments make sure that the.consolidation documents are uploaded on.here as well is that's the easiest thing.that we can look at to make sure that.what you sometimes you know if you.consolidated your loan that we approve.previously so let's say you know you you.were approved for fed loans and now.being and then you consolidated them.into one we just want to see that those.are the exact same holes that you've.consolidated so please submit your.documentation or your consolidation.documents and then additional documents.as I mentioned earlier only if you're.wanting to qualify for extra points.evidence of residency is what you're.going to score to be scored up for this.particular renewal so make sure that you.have a bit.the necessary documentation to show.proof that you have been residing in.Arizona physically for at least 12.months and if you click on that cross.mark icon you'll see all of the.different documents you can submit it's.a combination of these different.documents so if you think that your.driver's license already show that.you've been in Arizona for that long.then that would be good enough but if.not then you can of course submit more.than one document to show that okay.continue up sorry if continue and then.here it says you will not be able to.proceed past two points until after the.site has been complete the verification.so again because the site administrator.has not completed the verification.process you cannot get to the checklist.verification page which is the last.section before you submit your.application but I have a print screen of.that that I can show you all right so if.your if your site admin verifies your.employment completed that process.already then this is the next screen.this is the final screen that you'll see.which is the checklist verification on.top it basically tells you that the red.asterisk items are required for all.participants and then the yellow access.items you have to choose or or check one.of them and then the green asterisk.items are those that are only if.applicable you'll need to submit okay so.this last section is designed for to.help our applicants to ensure that their.application is as complete as possible.so here you have to check the boxes to.make sure that you've actually in fact.uploaded all of these documents so the.red item you absolutely need to check.them because they are required if you.don't check these boxes then you can't.move forward so for the purpose of.and you're not submitting a substitute.w94 which is only if you you have a.change in address obviously you're not.not going to submit substitute w9 for it.at this time but for the purpose of the.going through this process just check.that the overriding the system and then.you have to go through that list the ups.sorry and then the yellow item again.either/or so you have to check at least.one of the yellow asterisk item if.you're trying to quell you can of course.check both of them if you're providing.both the employment contract and.employment letter but if you only have.one let's say you only have the.employment contract and check the.employment contracts and then all of the.difference the the required items.underneath underneath that's what they.call this that item so so make sure that.your employment contract is a full time.employment for at least 40 hours or 20.hours a week employment start date name.and address of the server site if you're.submitting an employment letter and move.the contract then you check that.employment letter is what I'm sorry.what you're submitting and then all of.the boxes under gangsta' item and then.most recent billing statements and then.if applicable for consolidated loans.that it might break down on the.consolidated loans and that.documentation from the lender that the.most reviews solely for education so.once you've gone through this list and.you basically kind of confirm that yes I.checked I uploaded this this this and.this and you've gone through all of.these things that are required and you.know if applicable items then you can.hit the submit button and once you.submit you hit submit button there's a.pop-up message that will indicate that.you have successfully submitted your.application so if you didn't see this.pop up message confirm with us that we.actually have it in our queue because.this happened last year where the pop up.message did not come up and it could be.just a glitch in our system so if it.didn't come up and you don't have an.indication of whether you your.application has actually been submitted.just confirm a dozen we can tell you.once you hit submit it will tell you.that you will be navigated to the home.page which is the landing page and.that's it you're done and and when you.get to the landing page then you'll see.the completed application at the bottom.of that screen that I covered earlier so.that is it for the step by step for.customer support if you get stuck Ashley.and I are available my phone number and.Ashley's phone number as well as our.email addresses are provided here our.team I just want to thank everyone for.really our electronic system has been in.existence just for a year and we've had.a lot of successes in implementing the.system our goal is to enhance customer.experience hopefully this is going to be.an easier friendly user friendly.interface for all of you and a better.experience instead of Semitic paper.application and I've just finished with.the live demo I want to thank you all.for participating and we will open it up.for questions okay so for anyone who has.questions please use the chat box on the.right-hand screen like I had mentioned.earlier at the beginning of this webinar.we will be emailing everyone the.PowerPoint as well as the recorded.webinar we're also going to be posting.it on our website light I just want.everyone to remember that we will be.sending out the renewal codes.hopefully it's mid-february like Anna.had mentioned earlier please let us know.if you don't get that specific code for.renewal and we can provide that to you.okay it doesn't look like we have any.questions in the chat cube like Anna.mentioned we are available via email and.phone call preferably via email.can we start uploading okay so we did.get a question can we start uploading.information now no the answer's no.because we have sites.Kerli registering until february 28th.the application cycle does not open.until March 1st of 2019 so you won't be.able.to start doing your application until.then any other questions we will be.sending out a reminder email to everyone.letting them know when the application.cycle opens for renewing candidates this.will also be hopefully both well we're.not going to post it on our website.we'll just send it by a ml so watch out.for those email but you can always call.us at any time and we can confirm there.shouldn't be any change in the date that.the application period will open for.renewing candidates again it's March 1st.to April 1st is when you get rid of your.contract so on March 1 you can access.the portal you can initiate your.application you can submit all the.supporting documents or upload your.supporting documents but again if your.site administrators have not completed a.verification process you can you can.have your applications pan in the system.until such time that your employment.verification have been completed to.where you can submit the application.completely in the portal we have another.question in the loan section where we.enter the low numbers if I consolidated.do I have to enter each one or do I.enter the one consolidated loan with the.total amount if you consolidated your.loan say now it's handled through.mochila for example and what you're.going to enter as a loan servicer is.mochila and under the loan details all.you need to enter is the consultant it.is a loan that you consolidated so if.the mochila accounts now covers the Fed.loan and even though there are different.loans within said loan you don't have to.enter those loan details all you need to.enter is the Fed loan account that you.had consolidated with Mahela does that.answer your question.okay thank you Gina for confirming if.there's no above if there are any other.questions I remind you that you can use.the chat box any other questions that.you may have that you think of later on.you.can always call our email us you will be.receiving an email shortly from us with.the webinar information as well as.PowerPoint to help you and be used as a.resource but thank you everyone for.attending we know that this took a chunk.out of your day but thank you again and.we hope you have a good rest of your day.

How to generate an electronic signature for the Physician Certification Form Azdhs online

CocoSign is a browser based application and can be used on any device with an internet connection. CocoSign has provided its customers with the best method to e-sign their Physician Certification Form Azdhs .

It offers an all in one package including validity, convenience and efficiency. Follow these instructions to put a signature to a form online:

  1. Confirm you have a good internet connection.
  2. Open the document which needs to be electronically signed.
  3. Select the option of "My Signature” and click it.
  4. You will be given alternative after clicking 'My Signature'. You can choose your uploaded signature.
  5. Design your e-signature and click 'Ok'.
  6. Press "Done".

You have successfully signed PDF online . You can access your form and email it. Excepting the e-sign alternative CocoSign proffer features, such as add field, invite to sign, combine documents, etc.

How to create an electronic signature for the Physician Certification Form Azdhs in Chrome

Google Chrome is one of the most handy browsers around the world, due to the accessibility of a lot of tools and extensions. Understanding the dire need of users, CocoSign is available as an extension to its users. It can be downloaded through the Google Chrome Web Store.

Follow these easy instructions to design an e-signature for your form in Google Chrome:

  1. Navigate to the Web Store of Chrome and in the search CocoSign.
  2. In the search result, press the option of 'Add'.
  3. Now, sign in to your registered Google account.
  4. Access to the link of the document and click the option 'Open in e-sign'.
  5. Press the option of 'My Signature'.
  6. Design your signature and put it in the document where you pick.

After putting your e-sign, email your document or share with your team members. Also, CocoSign proffer its users the options to merge PDFs and add more than one signee.

How to create an electronic signature for the Physician Certification Form Azdhs in Gmail?

In these days, businesses have transitted their way and evolved to being paperless. This involves the signing contract through emails. You can easily e-sign the Physician Certification Form Azdhs without logging out of your Gmail account.

Follow the instructions below:

  1. Look for the CocoSign extension from Google Chrome Web store.
  2. Open the document that needs to be e-signed.
  3. Press the "Sign” option and design your signature.
  4. Press 'Done' and your signed document will be attached to your draft mail produced by the e-signature application of CocoSign.

The extension of CocoSign has made your life much easier. Try it today!

How to create an e-signature for the Physician Certification Form Azdhs straight from your smartphone?

Smartphones have substantially replaced the PCs and laptops in the past 10 years. In order to made your life much easier, CocoSign give assistance to flexible your workflow via your personal mobile.

A good internet connection is all you need on your mobile and you can e-sign your Physician Certification Form Azdhs using the tap of your finger. Follow the instructions below:

  1. Navigate to the website of CocoSign and create an account.
  2. Follow this, click and upload the document that you need to get e-signed.
  3. Press the "My signature" option.
  4. Draw and apply your signature to the document.
  5. View the document and tap 'Done'.

It takes you in an instant to put an e-signature to the Physician Certification Form Azdhs from your mobile. Load or share your form as you wish.

How to create an e-signature for the Physician Certification Form Azdhs on iOS?

The iOS users would be gratified to know that CocoSign proffer an iOS app to make convenience to them. If an iOS user needs to e-sign the Physician Certification Form Azdhs , make use of the CocoSign application relivedly.

Here's advice put an electronic signature for the Physician Certification Form Azdhs on iOS:

  1. Place the application from Apple Store.
  2. Register for an account either by your email address or via social account of Facebook or Google.
  3. Upload the document that needs to be signed.
  4. Select the section where you want to sign and press the option 'Insert Signature'.
  5. Type your signature as you prefer and place it in the document.
  6. You can email it or upload the document on the Cloud.

How to create an electronic signature for the Physician Certification Form Azdhs on Android?

The giant popularity of Android phones users has given rise to the development of CocoSign for Android. You can place the application for your Android phone from Google Play Store.

You can put an e-signature for Physician Certification Form Azdhs on Android following these instructions:

  1. Login to the CocoSign account through email address, Facebook or Google account.
  2. Open your PDF file that needs to be signed electronically by clicking on the "+” icon.
  3. Navigate to the section where you need to put your signature and design it in a pop up window.
  4. Finalize and adjust it by clicking the '✓' symbol.
  5. Save the changes.
  6. Load and share your document, as desired.

Get CocoSign today to make convenience to your business operation and save yourself a lot time and energy by signing your Physician Certification Form Azdhs online.

Easier, Quicker, Safer eSignature Solution for SMBs and Professionals

No credit card required14 days free