A medical professional liability application identified in the ACORD index. Current markets may use newer carrier or program applications, so the intended market must confirm the acceptable form and edition.
The fillable PDF is available through ACORD's licensed portal. This page is a preparation guide, not a hosted download.
Already have an eligible ACORD account? Open the Forms Portal and search for form 196. Check the edition your intended market accepts before completing it. An ACORD account and eligible Forms program are required.
Need help identifying the form or access path? Request access help from Hedge. This is a request for assistance, not an instant download or an insurance submission.
Preparation guidance from Hedge. Follow the instructions in the accepted form edition and the intended market's requirements.
A practice adds a new procedure and uses contract clinicians. Describe the procedure and staffing arrangement explicitly; the practice name alone does not explain the expanded services or supervision.
Hypothetical example, not a placement result or a coverage determination.
ACORD 196 adds medical professional information. ACORD 825 organizes professional and specialty applicant details. Confirm the intended insurer's own application requirements before completing a packet.
Read the ACORD 825 guideThe edition shown is the edition observed in the official index on the review date. Confirm the acceptable edition, jurisdiction, and related forms with the intended market. Hedge links to ACORD's licensed download source and does not host or redistribute the ACORD file.
These fillable Hedge resources can support preparation but do not replace a required ACORD or market-specific application.
A fillable Hedge supplemental for allied health and medical professional liability risks.
View form and fillable PDF →A fillable Hedge supplement for organizing prior losses, claims, and open-claim detail for wholesale review.
View form and fillable PDF →Request ACORD 196 from Hedge for help identifying the current edition and an authorized access path, or use ACORD's official Forms Portal. Hedge does not host or redistribute the ACORD PDF.
Professional services and procedures; Provider credentials and specialties; Patient population and locations; Staffing and supervision; Prior claims and known incidents.
No. That is the edition observed in ACORD's index on the source-review date. Confirm the edition, jurisdiction, related forms, and any market-specific application before releasing the packet.
Use the official source to confirm form availability, edition, jurisdiction, licensing, and related-form information.
Open official source →Use the official source to confirm form availability, edition, jurisdiction, licensing, and related-form information.
Open official source →Use the official source to confirm form availability, edition, jurisdiction, licensing, and related-form information.
Open official source →Use the official source to confirm form availability, edition, jurisdiction, licensing, and related-form information.
Open official source →Use the class submission guide to identify the underwriting facts and Hedge forms that may apply, then have Hedge confirm the intended market and route.