Malpractice face sheet 2026

1. Click ‘Get Form’ to open the malpractice face sheet in the editor.
2. Begin by entering your Clinician’s Name, Title, and Discipline at the top of the form. This information is essential for identification.
3. Proceed to the series of yes/no questions. For each question, select the appropriate response. If you answer 'Yes' to any question, provide a detailed description in the space provided.
4. In section A, list your Medical/Professional Associations or Society memberships. This helps establish your professional background.
5. For section B, detail all current contracts with HMO or managed care companies, including their names and approximate percentage of practice.
6. Complete section C if applicable, indicating whether you are a paid employee or consultant for any health care plan and providing relevant details.
7. In the Clinical Psychotherapeutic Expertise section, check at least three treatment modalities where you have training or experience.
8. Finally, briefly state your theoretical and practice orientation in treating Mental Health/Substance Abuse Problems before signing and dating the form.

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