Overview
Prototype · sample data

Walkthrough

The same sample record from two sides: Dr. Elena Ruiz, who owns it, and Example Locum Agency, which reads it under a grant. Nothing on these screens is sent anywhere.

Sample data

Grant access to an agency

Dr. Ruiz issued the Example Locum Agency grant on Sep 24, 2026. She shared three of the four credential types the agency asked for and left out malpractice.

Grant access

AgencyExample Locum Agency
What it can see
State licenses (shared) DEA registration (shared) Board certification (shared) Malpractice (not shared) Education (not shared) Work history (not shared)
PurposeAssignment credentialing
Access endsOct 31, 2026
Evidence documents included

Who can see my record

Example Locum Agency
State licenses, DEA, board certification · assignment credentialing
Ends Oct 31, 2026
Revoked Oct 2, 2026
Sample Regional Hospital
Full record · for privileging
Ends Nov 15, 2026

Every view by either organization appears in Dr. Ruiz's access log.

Sample data

New York Form 1 package

Form 1 is completed on the NYSED portal. We generate the package Dr. Ruiz files from, with the Form 1 answers taken from her record.

New York Form 1

3/6left
Form 1 answers from the record
License, exams, board certification
Answer 2 disclosure questions
Needed for the package
Explain work-history gap
Jul to Sep 2019
Medical education
Form 2: your section is filled in, and the school completes the rest

Form 1 is completed on the NYSED portal. We generate the package you file from.

Ohio renewal package

22 of 23 met · ready when the CME certificate is logged
1 item
  1. Renewal data sheet
    Every field filled from the record
  2. CME attestation
    Duty-to-report, 1 hour · not yet logged
  3. Disclosure answers
    Answered Sep 20, 2026
  4. Evidence documents
    4 files, each checked

Dr. Ruiz files the renewal on Ohio eLicense.

Sample data

Ohio medical license

Dr. Ruiz entered the license on Aug 30, 2026. J.M., a credentialing specialist, verified it against Ohio eLicense on Sep 4, 2026.

Ohio medical license

35.0XXXXX · State Medical Board of Ohio
Verified
Entered by clinician
Number
35.0XXXXX
Status
Active
Expires
Jan 1, 2027
Entered
Aug 30, 2026
Verified from primary source
Source
Ohio eLicense
Method
Staff lookup on the board's public site
Date
Sep 4, 2026
Verifier
J.M.
Result
Matches what was entered

Evidence and history

  • License certificate
    Uploaded Aug 30, 2026 · file checked
    Linked
  • Verified by J.M.
    Sep 4, 2026 · Ohio eLicense
  • Entered by Dr. Ruiz
    Aug 30, 2026

Other credentials

  • Board certification
    Verified from primary source · ABIM · Aug 28, 2026 · verified by K.T.
    Verified
  • Malpractice coverage
    Entered by clinician · waiting for verification
    Unverified
  • Medical education
    Request sent to the school
    In verification
Sample data

Verified credential packet

Prepared Oct 2, 2026 for Example Locum Agency. The packet holds only what Dr. Ruiz's grant covers.

Dr. Elena Ruiz

Internal medicine · NPI ••••••4302
  1. Grant terms
    Scope, purpose, and the Oct 31, 2026 end date
  2. Ohio medical license
    Verification record and license evidence
    Verified
  3. DEA registration
    Verification record and certificate
    Expiring
  4. Board certification
    Verification record from ABIM
    Verified

Left out by the grant

MalpracticeEducationWork historyScreening results

Each download is recorded in Dr. Ruiz's access log, like any other view.