PROFESSIONAL LIABILITY CLAIM REPORT FORM
This form is for insurers and other entities providing professional and/or supplemental liability insurance covering pharmacists, pharmacy technicians, and/or pharmacies. Pharmacists, pharmacy technicians, or pharmacy license holders are required to complete this form, only under the following conditions: (1) if a pharmacist, pharmacy technician, or a pharmacy licensed in Texas does not carry or is not covered by professional liability insurance or supplemental liability insurance; or (2) if a pharmacist, pharmacy technician, or a pharmacy licensed in Texas is insured by any other entity providing pharmacy professional liability insurance that does not report under the Texas Pharmacy Act. Reports must be made on a Professional Liability Claim Report Form. Please note that reports are required for claims initiated or resolved on or after September 1, 1999. Claims which are not required to be reported include the following: product liability claims, antitrust allegations, allegations involving improper peer review activities, civil rights violations or allegations of liability for injuries occuring on a licensee's property, but not involving a breach of duty.
You may download a Professional Liability Claim Report Form here!