Forms
PublicationsForms
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Informed Consent Documents
Gastric Bypass Roux-en-Y (Word Document)
Appendectomy (Word Document)
Lap Band (Word Document)
Generic Consent (Word Document)
Caesarian Section (Word Document)
Laparoscopic Cholecystectomy (Word
Document)
Anesthesiology (Word Document)
Consent Documents
Consent for Chronic Opioid Therapy (PDF)
Application Forms
Individual Application
(PDF)
UMIA
Membership Application and Power of Attorney (PDF)
Prior Acts Coverage Application
(PDF)
Additional
Named Insured/Separate Entity Application (PDF)
Independent Corporation/Partnership/LLC
Locum Tenens Application
(PDF)
Additional Named Insured
Ancillary Personnel (PDF)
Risk Management
Patient Encounter and Evaluation Form - Chest Pain (Word Document)
Arbitration Downloads
Certification of Arbitration:
This document is to be downloaded, signed and dated to certify compliance with implementation of arbitration by an individual or group practice.
Written Explanation of Arbitration
for Patients:
This handout is presented to patients for compliance with the requirement
they receive a written description of arbitration.
Arbitration Agreement:
The current approved arbitration agreement that is to be used for
all new agreements and to replace all older versions. Older versions
must be replaced with this document at renewal.
