Get Masm 5018 2010-2025

Filling out the MASM 5018 form for professional liability insurance is an essential process for practitioners in specified medical professions. This guide will walk you through each section of the form, ensuring you complete it accurately and efficiently.

Follow the steps to successfully complete the MASM 5018 online.

1. Press the ‘Get Form’ button to obtain the MASM 5018 form and open it for editing.
2. Begin by entering your applicant information, including your full name and professional degree. Make sure to provide your principal business address, including street, city, county, state, and zip code.
3. Complete the section that requires you to specify the number of employees in various categories: full-time, part-time, and seasonal. Add the total number of employees as well.
4. Provide your business phone number, home phone number, and date of birth. Indicate your place of birth and confirm whether you are a U.S. citizen.
5. Fill in the square footage of your total office space and select your practice type from the list provided, including options such as solo practitioner, professional corporation, and partnership.
6. List the names of all partners or members in your professional association or corporation who provide services.
7. Attach a copy of your letterhead and complete the HIPAA compliance section, indicating whether you are a covered entity and providing the name and title of your Privacy Officer if applicable.
8. In the education and experience section for individual applicants, detail your training, including institution names, years of training, and degrees attained.
9. List your practice history for the last ten years, including the locations and time frames of your practice.
10. Indicate your professional specialty by checking the appropriate option and provide any relevant details.
11. Complete all remaining sections, ensuring you answer all questions, sign, and date the application. Finally, save changes and consider downloading, printing, or sharing the completed form.

Complete your MASM 5018 form online today to ensure you have the necessary professional liability insurance.