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Medical Staff Verifications

You've been asked to complete a professional reference for a health-care provider who has applied for appointment/reappointment to Osceola Medical Center. Please complete all sections of this online form with (*). If you have any questions or would like to submit a PDF, please email OMC's Credentialing at or fax 715-294-4822.

Applicant is qualified for clinical privileges requested:
Do you recommend this applicant for participation?

Thanks for submitting!

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