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Indiana Department of Insurance
IDOI > Surcharge Rates / Calculation Sheets > Calculation Sheets & Certificate of Insurance Calculation Sheets & Certificate of Insurance
IDOI provides you with the right forms and information so that your Patient's Compensation Fund filings are organized and processed correctly.
- Patient's Compensation Fund Nursing Home Calculation Sheet Effective 6/28/12
- Patient's Compensation Fund Hospital Calculation Sheet Effective 3/1/12
- Patient's Compensation Fund Nursing Home Calculation Sheet Effective 3/1/12
- Patient's Compensation Fund Hospital Calculation Sheet Effective 3/1/11
- Patient's Compensation Fund Nursing Home Calculation Sheet Effective 3/1/10
- Instructions for Self-Insured Hospital Filings
- Locum Tenen Calculation Sheet
Certificate of Insurance
A Certificate of Insurance certifies limits of liability on behalf of the referenced health care provider.
Download the Certificate of Insurance.
Reporting Endorsement Factors.
PCF Frequently Asked Questions
