Get Prms Fa-py-402-b-ok 2019-2025

Filling out the PRMS FA-PY-402-B-OK is a vital step for individuals seeking medical professional liability insurance. This guide will provide you with clear instructions to complete the form accurately and efficiently online.

Follow the steps to effectively complete the PRMS FA-PY-402-B-OK form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your full name, including any titles, in the 'Applicant Name' field. Then, input your date of birth in the designated format: Month, Day, and Year.
3. Fill in your mailing address, city, state, and zip code. Make sure all information is accurate to ensure proper correspondence.
4. Provide your mobile number, website, and email address. If there is an authorized contact other than yourself, include their information.
5. List your active license number and the state in which it is held, along with any psychiatric association memberships.
6. Under 'Coverage Requested', enter the effective date of coverage and select the limits of liability that you are requesting.
7. Choose the type of coverage you prefer: 'Occurrence' or 'Claims Made'. If applicable, provide the retroactive date for claims-made coverage and indicate if you have prior acts coverage.
8. Detail your practice specialty by indicating percentages for each specified area, such as general psychiatry or child and adolescent psychiatry.
9. Specify the average number of hours you will work each week. If you plan to perform activities covered by another liability policy, indicate this as well.
10. Answer the residency or fellowship question regarding your current status and provide the completion date if applicable.
11. Complete the section regarding continuous medical professional liability insurance coverage.
12. Fill out any relevant information regarding your practice locations, including name and address, as well as the percentage of time spent at each location.
13. Respond to all additional information prompts, ensuring truthful and complete answers.
14. Review the entire form for accuracy and completeness before saving or submitting.
15. Once finished, save your changes, download, print, or share your completed form as needed.

Complete your forms online today to ensure you have the coverage you need.