Full Name
*
Mobile Number
*
Email Address
*
Home Location: City and State
*
Active State Medical Licenses
*
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:
*
Onsite near home location
Relocation interest
On a range, how many patients are you treating per 8 hr shift on average?
1-5
6-10
11-20
21-40
41-60
61-80
81-100+
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)
Case Preference: Which type of patients do you feel comfortable treating at this time?
Yes, MedAtlantic Healthcare Solutions LLC can contact me about job opportunities.
I may receive phone/text communications about career opportunities, interviews, job offers, and other related information from MedAtlantic Healthcare Solutions LLC (+1 (727) 496-7740) (Message and data rates may apply, message frequency varies). I may receive emails from medatlantichcs.com. I can opt-out at any time by unsubscribing or texting STOP. My data will be handled in accordance with
the privacy policy
. Terms of service:
https://loxo.co/legal/master-subscription-terms-of-service-agreement
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support@loxo.co
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