Sample Forms, Checklists, and Letters for ProAssurance Insureds

You deserve to have top-notch risk management resources to help you lessen uncertainty and exert more control. That’s only fair, since your professional identity is on the line. We can help save you time with a variety of editable templates you can modify to fit your needs. 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 template modifications.

ProAssurance insureds 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 business 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

ProAssurance insureds also have access to our Risk Management Guidelines. These Guidelines provide to-the-point information on over 20 topics, covering the most vexing subjects in healthcare today.

Do you have a suggestion about additional forms, checklists, or letters you’d like to see? Or a suggestion about how we can improve an existing form? Please let us know. Thank you.