An Affidavit is a sworn, written statement of facts, signed by the 'affiant' (the person making the statement) before a notary public or other official witness. The affiant swears to the truth and accuracy of the statement contained in the affidavit. This document, an Affidavit of Physician , is a model affidavit for recording the type of information stated. It must be signed before a notary, who must sign and stamp the document. Adapt the text to fit your facts. Available for download now in standard format(s). USLF control no. MS-60007
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Affidavit Regarding Background Study. GAC103. DHS Background Check Form and Information Sheet. GAC104.If more than one physician shares that responsibility, any of those physicians may act as the attending physician under this Act. Option you must also complete the "Financial Responsibility Affidavit of Exemption" form that follows this page): a. The law specifically required that this group of physicians complete this training in addition to the usual CME required for relicensure.