Healthcare and human services
Hedge Allied Health and Medical Professional Supplemental
A fillable Hedge supplemental for allied health and medical professional liability risks.
View form and fillable PDF →Commercial insurance form reference
ACORD 196: Medical Professional Liability Insurance Application.
Direct answer. 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.
Information organized
Facts to prepare.
- Professional services and procedures
- Provider credentials and specialties
- Patient population and locations
- Staffing and supervision
- Prior claims and known incidents
Quality control
Review before using the form.
- Confirm the intended market's accepted application
- Keep protected health information out of public URLs and resources
- Explain higher-hazard procedures and staffing arrangements
Edition and market boundary
The 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 does not provide this ACORD file for download.
Related Hedge forms
Hedge-owned supplements that may add class detail.
These fillable Hedge resources can support preparation but do not replace a required ACORD or market-specific application.
Any risk
Hedge Loss and Claims Supplement
A fillable Hedge supplement for organizing prior losses, claims, and open-claim detail for wholesale review.
View form and fillable PDF →Sources
Verify against the publisher.
Official source
ACORD Forms Index
Use the official source to confirm form availability, edition, jurisdiction, licensing, and related-form information.
Open official source →Official source
ACORD Forms Portal
Use the official source to confirm form availability, edition, jurisdiction, licensing, and related-form information.
Open official source →Official source
ACORD Forms Search Tools
Use the official source to confirm form availability, edition, jurisdiction, licensing, and related-form information.
Open official source →Next step
Assemble the account-specific packet.
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.