Help Center / What documents are needed to register with this program?


Office Surgery Registration Form with an original signature for registering Surgeon Copy of current accreditation certificate and survey, if applicable. Documentation to demonstrate satisfactory completion of training such as:
Board certification or Board qualification by a Board approved by the American Board of Medical Specialties or any other board approved by the Board of Medicine orĀ  Documentation to demonstrate knowledge of the principles of general anesthesia (ACLS or BLS certification) Additional documentation required for registration to perform levels II & III Office Surgery with this program. Name and license number of any Surgeon, Physician Assistant (PA), Certified Registered Nurse Anesthetist (CRNA), Advanced Practitioner Registered Nurse (APRN), or Registered Nurse (RN) at facility Copies of any protocols necessary for the supervision of any PA, CRNA or APRN. Copy of current ACLS Card for Surgeon and at least one assistant Name and license number of M.D. or D.O. Anesthesiologist, if applicable



Supporting Documents

Medical Degree Verification
NICA FORM
Postgraduate Training Verification
License Verification

Supporting Documents - Visiting Physician

NICA FORM