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ILM Covers 4Q 2016 USE FINAL Select REV Layout 1 11/3/16 10:22 AM Page 2APIAAPUBLICATIONFORTHEMEDICALPROFESSIONALLIABILITYCOMMUNITYInside Medical Liability WWW.PISA.US2016FOURTHQUARTERChanging Medicine:
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First, gather all the necessary information about the physician you are filling out the form for. This may include their name, contact details, and medical specialization.
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Next, carefully read through the form instructions to ensure you understand what information needs to be provided.
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Start by entering the physician's personal details such as their full name, date of birth, and gender.
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Provide the physician's contact information, including phone number, email address, and residential address.
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Indicate the medical school attended by the physician as well as their graduation date.
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Specify the physician's specialization or area of expertise, such as cardiology, dermatology, or pediatrics.
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Include any certifications or accreditations the physician may have obtained, along with their expiration dates.
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If applicable, provide details of the physician's previous work experience, including the name and location of previous practices or hospitals.
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Check if any additional supporting documents are required, such as a copy of the physician's medical license or CV, and attach them to the form if necessary.
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Double-check all the information provided for accuracy and completeness before submitting the form.

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Hospitals and healthcare facilities require physicians to provide medical services to patients.
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Insurance companies may need physicians to validate medical claims or provide expert opinions.
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Pharmaceutical companies often work with physicians for drug trials and research purposes.
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Government agencies may require physicians for public health programs and initiatives.
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Legal professionals may seek the expertise of physicians as expert witnesses in medical cases.
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