Form Name:	Malpractice Form
Completed By:	Program Coordinator
Used When:	Submitted yearly to request malpractice coverage for active residents at specific hospitals.
Purpose:	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:	Malpractice REQUEST FORM revised 2023.pdf

Instructions for Completing Form for Active House Officers

Print the Malpractice Spreadsheet, attach to this form, and submit to the GME office for GME signature. Once processed in GME, it will be sent to the Vice Chancellor's office. When filling out the Malpractice Form, only 1 copy of the form needs to be filled out and submitted. Under the "Name" and "Title" fields in the form, put "See Attached" as the spreadsheet will have all of the needed information for each resident.

Instructions for Prior House Officers

Requester should contact Cynthia Scott directly.

Places This Form is Referenced

Page:

Malpractice Form (Forms & Documents) — Combined with the Malpractice Spreadsheet, this form is submitted to the Vice Chancellor's Office to request verification of malpractice coverage for residents.

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