合格​​ 

这种登记类型仅适用于个人认证护士助产士，他们在 Medi-Cal 登记的持牌初级保健诊所专门提供初级保健服务，没有其他固定的营业地点（即医疗办公室）提供服务，并且需要为在综合急症护理医院为受益人提供的住院产科服务开具账单。 团体不符合此类招生资格。​​ 

Pursuant to the regulatory Provider Bulletin published in June 2009, effective July 15, 2009, DHCS has established procedures for the enrollment of certified nurse midwives who are solely employed by or provide services pursuant to a contract with licensed primary care clinics, and who do not have any active Medi-Cal provider number issued to them individually to bill for clinical services to Medi-Cal beneficiaries at another location and as such, use the licensed primary care clinic as their established place of business. This type of enrollment allows the certified nurse midwife to bill for inpatient services only and not for services provided at the Licensed Primary Care Clinic. In order to determine whether or not you qualify for this type of enrollment, please read the detailed Provider Bulletin: “Requirements and Procedures for ‘Clinic-Based Certified Nurse Midwife’ Enrollment”.​​ 

如果您有资格注册成为诊所认证护士助产士：诊所认证护士助产士必须通过 PAVE（提供者申请和注册验证）提交个人申请。​​ 

许可​​ 

在申请 Medi-Cal 之前，请先检查加州注册护士委员会网站，以确保您满足所有许可要求。​​ 

所需文件​​ 

接下来，收集下面列出的所需文件（如适用），以便在完成 PAVE 申请时将它们上传到 PAVE。 请确保上传的文件清晰易读。​​ 

1. 当前的加州护理执照和
   持有助产士资格证书。如果适用，还请附上您的 DEA 注册证书和/或助产士提供编号。​​ 
2. 签署申请表的申请人的驾驶执照或州政府颁发的身份证（在美国 50 个州或哥伦比亚特区内颁发）。 签名必须是注册护士助产士申请人的签名。​​ 
3. 助产士申请人的联邦雇主识别码（FEIN）验证、
   只有在未使用社会保险号的情况下，才需提交由美国国税局 (IRS) 生成的最新文件。唯一可接受的文件包括 IRS 生成的 Letter 147-C、IRS 生成的 Form 941（雇主季度联邦报税表）、IRS 生成的 Form 8109-C（存款凭单）或 IRS 生成的 Form SS-4（仅指正式的 FEIN 分配确认通知）。注意：申请表上申请人或提供方的法定名称必须与国税局生成的文件上的名称完全一致；申请人/提供方必须是国税局文件上所列实体的所有者或高级职员。有关详细信息，请访问
   或致电 (800) 829-4933。​​ 
4. Licensed Primary Care Clinic Cover Letter from each Medi-Cal-enrolled clinic at which you provide services. The letter should include the required information as described on pages three and five of the provider bulletin titled, “Requirements and Procedures for ‘Clinic-Based Certified Nurse Midwife’ Enrollment”.​​ 
5. Certified Nurse Midwife Cover Letter (at least one) that includes the required information as described on pages four and five of the provider bulletin titled, “Requirements and Procedures for ‘Clinic-Based Certified Nurse Midwife’ Enrollment”.​​ 
6. 专业责任保险证书，每次索赔的保额不少于 100,000 美元，每年最低累计保额为 300,000 美元。 可接受的验证是保险公司出具的保险证明或声明单，其中包含保险公司的名称、被保险人的姓名、生效日期和承保限额。 注意：医疗服务提供者的姓名（如加州医疗执照上所显示的）也必须显示在专业责任保险的验证上。​​ 
7. 如果您是公司法人，可通过附上一份从州务卿处提交的
   州务卿备案的公司章程副本，以及董事和高级职员的姓名和头衔清单，并注明每位董事和高级职员的所有权和控制权百分比。
   
   ​​ 
8. 您的虚拟商业名称声明的副本（仅当适用时）。​​ 

PAVE 门户​​ 

继续​​  PAVE门户。​​