Claims History Request

Please contact the Medical Center Risk Management Office for questions relating to Professional Liability and Claims History Requests. They can be reached at 415-353-1842.

When you are credentialed at our hospital, an affiliated hospital, or at an outside institution, the Medical Staff Office will request information about any claims or actions against you (claims history) as part of the credentialing process. With external requests, they will also require the name and your malpractice coverage and type of coverage. With your written authorization, Risk Management will research your UC claims history, and respond with an original letter to the facility stating that you are/were covered by UC’s malpractice insurance (coverage dates equal your dates of employment), and verify your claims history.

Risk Management will report claims or litigation arising from alleged professional liability in which the provider was either a named party, or in which the provider's care was the subject of the claim, and reported to us within the past six (6) years. We will also report with respect to claims, which has not been the subject of suit, if settled by payment on behalf of the provider at UCSF.

A claims history requires your signed authorization to permit release of this confidential information. Please click on the link below to open and print the form.

AUTHORIZATION TO RELEASE CLAIM HISTORY FORM

  1. Complete your department and dates of employment.
  2. Complete the facility's name and address to which you are applying. If you wish a copy faxed to the facility please provide the fax number. One request per form please.
  3. Print your name, sign, and provide your social security number on the form.
  4. Mail or fax (415) 353-8566 the completed form to Risk Management. Claim history responses may take up to14 days upon receipt of request. If you have an urgent request, please contact us.

Note: If you wish to receive a copy, please provide your mailing address or a fax number.

If you have any additional questions, please contact the Sr. Risk Analyst at (415) 353-1842.