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Form Name:

Malpractice Form

Completed By:

Program Coordinator

Used When:

Submitted yearly to request malpractice coverage for active residents at specific hospitals.

Purpose:

Excerpt
Combined with the Malpractice Spreadsheet, this form is submitted to the Vice Chancellor's Office to request verification of malpractice coverage for residents.

Direct Questions To:

Cynthia Scott

Form Link:

Instructions for Completing Form

Print the Malpractice Spreadsheet, attach to this form, and submit to the Vice Chancellor's office.

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