Malpractice Spreadsheet

Form Name:Malpractice Spreadsheet
Completed By:Program Coordinator
Used When:Submitted yearly to indicate active House Officers who need Malpractice Insurance coverage.

Required for providing proof of malpractice insurance to hospitals.

Direct Questions To:Cynthia Scott
Form Link:GME Online Appointment Forms

Instructions for Completing Form

Download form from GME Online Appointment Forms and submit with Malpractice Request Form to Cynthia Scott.

The Office of Risk Management provides confirmation of malpractice coverage of the upcoming academic year’s House Officers as of July 1st  to the various rotation sites. In order to coordinate disbursement to all rotation sites a complete listing of all house officers and a complete listing of all sites the program will be rotating is required. After MATCH please forward to Cynthia Scott by March 31st, the COMPLETE listing of all your house officers and an excel spreadsheet of a COMPLETE Listing of all sites they will be rotating for the next academic year. Please complete a single  Malpractice Request form for ALL House Officers of Academic Year and attach to the spreadsheets as outlined in the directives. Please make sure the spreadsheet listing the officers, has 1) header identifying the  OFFICIAL name of the program and 2) a footer indicating contact information of the program (i.e. department head/coordinators name, address and phone number).  This information is to be forwarded to the DEPT HEAD for signature, then to GME for approval and GME will forward to Claims for processing.

Other Info

See GME Online Appointment Forms for additional information about downloading form.

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