Get La Doa Pcf1 2015-2025

The Louisiana Patient's Compensation Fund MD & Advanced Practice RN's application, known as the PCF1 form, is essential for healthcare providers seeking coverage under the fund. This guide provides clear and concise instructions on how to effectively complete the form online, ensuring that all necessary information is accurately provided.

Follow the steps to complete the LA DoA PCF1 online:

1. Press the ‘Get Form’ button to access the PCF1 form and open it in your preferred online document editor.
2. Begin by filling in the provider details section. You will need to provide your complete name and mailing address, along with your license number, date of birth, and professional specialty. Ensure that all required fields are completed.
3. Move to the primary coverage section. Here, the Certificate of Insurance (COI) or declarations page from your insurer's policy is mandatory. Fill out the name of the insuring company, policy number, effective date, expiration date, and any applicable retroactive date. Indicate whether your policy is a claims made or occurrence form.
4. Specify the primary premium and PCF surcharge, along with your professional liability limits for each claim and the aggregate amount. If you work less than 20 hours a week, indicate this and complete the PCF12 form.
5. Indicate if you are employed as a Medical Director at a facility and list any relevant medical or surgical procedures you perform from the provided options.
6. Review the claims made policy section. Understand that your primary insurance provides claims made coverage, and be aware of the coverage limitations regarding the retroactive date.
7. Affirm that you meet the necessary qualifications for the Louisiana Patient’s Compensation Fund. Make sure to review the conditions stipulated, such as carrying the required underlying malpractice liability coverage.
8. Once you have completed the entire form, ensure that you print and sign it. The signed form must be mailed or faxed to the Louisiana Patient's Compensation Fund along with any additional required documentation.

Complete your LA DoA PCF1 form online today to ensure adequate coverage.