DOH Form 665-011 Request for Physician Disciplinary Profile / Pmlexis Score Report - Washington

DOH Form 665-011 Request for Physician Disciplinary Profile / Pmlexis Score Report - Washington

What Is DOH Form 665-011?

This is a legal form that was released by the Washington State Department of Health - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is form 665-011?A: Form 665-011 is the request form for a Physician Disciplinary Profile/PMLEXIS Score Report in Washington.

Q: What is a Physician Disciplinary Profile?A: A Physician Disciplinary Profile is a report that provides information about a physician's disciplinary history.

Q: What is a PMLEXIS Score Report?A: A PMLEXIS Score Report is a report that provides information about a physician's performance on the PMLEXIS exam.

Q: Who can request form 665-011?A: Anyone can request form 665-011 to obtain a Physician Disciplinary Profile/PMLEXIS Score Report in Washington.

Q: How can I obtain form 665-011?A: You can obtain form 665-011 by contacting the appropriate authority or agency in Washington.

Q: Why would someone request a Physician Disciplinary Profile/PMLEXIS Score Report?A: Someone might request a Physician Disciplinary Profile/PMLEXIS Score Report to evaluate a physician's qualifications or to make an informed decision about their healthcare provider.

Q: Is there a fee for requesting form 665-011?A: Yes, there may be a fee for requesting form 665-011. The specific fee amount can be obtained from the appropriate authority or agency in Washington.

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Form Details:

  • Released on August 1, 2016;
  • The latest edition provided by the Washington State Department of Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of DOH Form 665-011 by clicking the link below or browse more documents and templates provided by the Washington State Department of Health.

Download DOH Form 665-011 Request for Physician Disciplinary Profile / Pmlexis Score Report - Washington

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