 |
| PLEASE MAIL COMPLETED PAPER
APPLICATIONS |
| AND REQUIRED SUPPORTING DOCUMENTS TO |
| Credentialling Department |
| Medical Network, Inc |
| P O BOX 15253 |
| Portland, ME 04112 |
You can download various MedNet applications by clicking on the "Download" link to the right
of it's description.
All doctoral applications can be completed online then printed or printed then completed by hand.
Additional supporting documentation must be printed then completed by hand.
| Physicians |
| |
Application Instructions for Doctoral Level Providers |
| |
ME Physician Application - Use for all doctoral level providers, including
physicians, chiropractors, psychologists. This application is from OmniForm. It cannot be saved into
Word; it can be saved onto your hard drive. We suggest the desktop. After the
application has been opened it can be filled out on the computer and then printed. DON'T FORGET THE SUPPLEMENTAL
MATERIALS BELOW! |
| |
Addendum for Nurse Practitioners |
Professional Staff |
| |
Application Instructions for Non-Doctoral Providers |
| |
ME Non-Doctoral Application - Use for non-doctoral level providers,
including Nurse practitioners and nurse midwives, physical herapist, speech language pathologist, etc. Nurse practitioners and nurse midwives
must also include the Nurse Addendum below.
This application is from OmniForm. It cannot be saved into
Word; it can be saved onto your hard drive. We suggest the desktop. After the
application has been opened it can be filled out on the computer and then printed. |
Nursing |
|
You may need to supply additional documentation to complete the processing of
your application.
Download
the MedNet or UnitedHealthcare Preferred Provider Manual.
Viewing of pdf files requires the Adobe Acrobat reader.
If you do not have the
reader you can download it here:
|
