Sample Forms, Checklists, and Letters for ProAssurance Insured Physicians

You deserve to have top-notch risk management resources to help you lessen the uncertainty you face within your practice and exert more control. That's only fair, since your professional identity is on the line. Our goal is to help save you time by providing a variety of templates your practice can edit to fit its needs, as you deem appropriate. Since laws vary from state-to-state, please contact ProAssurance Risk Management to discuss specific situations or if you would like us to review your practice's template modifications.

Insured physicians and group-policy authorized representatives with a registered password for this website can access these templates by clicking the "Download" button next to the desired document. Clicking “Download” when you are not logged in will redirect you to a login screen before you are able to access the templates.

Customers needing to create a web account may sign-up here. Please note: account verification may take up to two days, which enables us to keep confidential information secure.

Sample Forms

  • Refusal of Treatment Form
  • Tracking and Follow-Up Log
  • Patient Complaint Form
  • Patient Authorization to Release Medical Information Form
  • Informed Consent Form

Checklists

  • Informed Consent Checklist
  • Unlicensed Employee Skills Checklist

Patient Letters

  • Withdrawal from Care or Termination Letter
  • Patient Notification Letters
    • When Closing a Solo Practice
    • When Leaving or Retiring from a Group Practice
    • When Selling a Solo Practice

Physicians who are insured by a ProAssurance company also have access to Risk Management Guidelines for ProAssurance Insured Physicians. These Guidelines give to-the-point information on over 20 topics, covering areas that physicians and practice managers have told us are the most vexing in medical practices.

Do you have a suggestion about additional forms, checklists, or letters that would be valuable to you? Or a suggestion about how we can improve an existing form? Please let us know. Thank you.