["Ophthalmologist - 2340011", "MedAtlantic Healthcare Solutions LLC"]

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?

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?

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