Instructions for Provider Disclosure Statement Form - Delaware

This document was released by Delaware Department of Services for Children, Youth and their Families and contains the most recent official instructions for Provider Disclosure Statement Form .

FAQ

Q: What is the Provider Disclosure Statement Form?
A: The Provider Disclosure Statement Form is a document used in Delaware to disclose information about a healthcare provider.

Q: Who needs to complete the Provider Disclosure Statement Form?
A: Healthcare providers in Delaware need to complete the form.

Q: What information is required in the form?
A: The form requires the provider to disclose information about their education, training, experience, and any disciplinary actions.

Q: When does the form need to be completed?
A: The form needs to be completed and submitted when applying for a healthcare provider license or renewal.

Q: What are the consequences of not completing the form?
A: Failure to complete the form accurately and honestly may result in disciplinary action against the provider's license.

Q: Are there any exemptions or waivers for the form?
A: There are no exemptions or waivers for the Provider Disclosure Statement Form. It must be completed by all healthcare providers in Delaware.

Q: Can the information disclosed on the form be accessed by the public?
A: Yes, the information disclosed on the form is public information and can be accessed by the public.