| Form Name: | Malpractice Form |
|---|---|
| Completed By: | Program Coordinator |
| Used When: | Submitted yearly to request malpractice coverage for active residents at specific hospitals. |
| Purpose: |
|
| Direct Questions To: | Cynthia Scott |
| Form Link: | Malpractice Form 2015.pdf |
Instructions for Completing Form for Active House Officers
Print the Malpractice Spreadsheet, attach to this form, and submit 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
-
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.