Get Professional Liability Face Sheet

Completing the Professional Liability Face Sheet online is an essential step for interns, residents, and fellows at MCV seeking to obtain documentation related to professional liability. This guide provides clear, step-by-step instructions to help users navigate the process effectively.

Follow the steps to successfully complete your Professional Liability Face Sheet

1. Click the ‘Get Form’ button to access the form and open it in an online editor.
2. Begin by filling out your name and address in the designated fields at the top of the form. Ensure that you provide accurate information as this will be used for correspondence.
3. Locate the section requesting your current policy number. Since you are self-insured, simply enter 'self-insured' in this field.
4. For the current effective dates, fill in '7-1-07' to '6-30-08'. This specifies the coverage period applicable to your request.
5. In the current limits section, you will need to input the coverage amounts: $1,925,000 for each medical incident and $5,775,000 for the annual aggregate.
6. Check the appropriate boxes to indicate which documents you wish to receive: Certificate of Coverage, Claims History, or both.
7. Authorize the VCUHS Department of Professional Liability to send the requested information by signing your name and entering the date in the respective fields.
8. Finally, review all your entries for accuracy. Once confirmed, you can save your changes and proceed to fax the completed form to the Professional Liability Office at the specified number (7836012). Ensure no cover sheet is required.

Take the next step by completing your Professional Liability Face Sheet online today!