MEDEX Reference (Optional)

MEDEX strongly prefers references from physicians and a midlevel provider (i.e., PA or ARNP), if the CASPA three (3) references do not include a reference from a physician or midlevel provider you may submit one (1) additional reference to be sent directly to MEDEX—this optional reference must be from a physician (MD, DO) or a midlevel provider (PA, NP).

Strong references include:

  • Statements speaking to individual clinical capabilities
  • Professional, long-term, direct connection with the reference provider
  • Well-written letters of support

The MEDEX reference forms are available through the MEDEX website and must be downloaded to fill out; MEDEX cannot receive electronic references at this time.

References are composed of three parts:

  • Part I of the form must to be filled out and signed by you and your reference.
  • Part II is the rating sheet
  • Part III is the letter that must accompany the form.

All three parts of the reference must be received by MEDEX in a sealed envelope with the reference’s signature across the sealed flap to be considered valid. Opened references will not be accepted.

References must be received by the October 1st application deadline to be considered.

MEDEX Reference Form


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