["Anesthesiology Physician", "MedAtlantic Healthcare Solutions LLC"]

Full Name *

Mobile Number *

Email Address *

Home Location: City and State *

Active State Medical Licenses *

Current Status

Current Work Environment *

Onsite
Telemedicine
Onsite and Telemedicine

Current Employment Status: *

Employed Part time
Employed Full time
Contracted for Locums

Please describe your current monthly schedule format and exact hours of your shifts: *

Currently Active Certifications: *

Actively Board Certified - M.D.
Actively Board Certified - D.O.

Fellowship information: Please add any completed fellowships here *

Preferred Evironment: *

Telemedicine
Onsite near home location or relocation interests
Relocation interest

Preferred Schedule: (Please check all that apply) *

Part time (Ex. Less than 24 hours a week)
Full time (Ex. 35+ hours a week)
Early am start (Ex. Starting at 4a - 7am)
Normal Day shift hours (Ex. Starting at 8 or 9am)
Mid-day Start (Ex. Starting anywhere between 10am-2pm)
Swing Shift (Ex. Starting anywhere between 3pm-6pm)
Overnight (Ex. Starting anywhere between 7pm-4a)

Open to covering weekends? *

Yes
No
Negotiable

On a range, how many patients are you treating per 8 hr shift on average?

Case Preference: Which type of patients do you feel comfortable treating at this time? (Check all that apply) *

General Anesthesia
Pediatric Anesthesia
ANESTH. AND PERIOPERTIVE TRAUESOPHAGEAL ECH.
PAIN MGT
CRITICAL CARE
CARDIOTHORACIC

Current Patient Mix Data: Please share on a rough % percentage break down of teh type of patients you see on shift on average *

Malpractice History *

No malpractice settlement pay outs, no pending cases, no license actions, and no dismissed cases in my entire career as a physician
1 or more "Settlement Pay outs" in my entire career as a physician
1 or more dismissed cases in my entire career as a physician
1 or more pending cases in my entire career as a physician

If you checked off any malpractice in your entire career as a physician, please share the "year" the cases surfaced and the outcome, (If a settled pay out case, please share your pay out $ portion)

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