New Hire/Volunteer Notification
New hires and volunteers delivering healthcare services under the following license types, with the exception of those with training licenses, are required to complete and submit a Professional Liability Questionnaire (PLQ): MD, DO, DMD, DPM, PhD, PsyD and PharmD
New healthcare providers that do not require a PLQ (as described above) and hospital employees requiring credentialing need to have a New Hire Notification form submitted on their behalf. This form is only to be completed and submitted by a clinical unit’s designated HR Representative, Division Administrator, Chair, Dean or their designated delegates.
Community Service
Extra-Curricular Student Activity
Visiting Student
This webpage, Coverage Forms, is managed by Lynette Belforti, Operations & Underwriting Officer.
Please feel free to contact her for any questions or recommendations regarding page content.
