HEALTH CARE PRACTITIONERS
SUBMISSION REQUIREMENTS

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Physicians, Chiropractors and Podiatrists

• Applicable Application
• Current valued loss reports:
  • Five years for Chiropractors and Podiatrists
  • Seven to ten years for Physicians
  • Depending on claim history, a supplement may be required.
• Advertising materials
  
• Copy of letter head
  
• State license
  
• Curriculum Vitae (resume)
  
• Copy of current declaration page

Additional requirements for Podiatrists only

• Copy of DEA (drug enforcement administration) card

Additional requirements for Chiropractors only

• Copy of Risk Management procedures
• Copy of written patient safety policy / practice standards
• Copy of informed consent