If you are requesting privileges at a facility, and verification of your terms of coverage at Washington University is required for a new employer or insurer, you may submit a request for confirmation of insurance by clicking on the link 

provided below:

Online Request Form

If malpractice claims history is needed, you will need to provide us with a written and signed release before the information will be provided. A release form (suitable for printing) may be accessed by clicking on the link provided below: 

Release Form

Any questions regarding these forms may be directed to Regina Swink of the Risk Management Office at (314) 362-4659, or via e-mail at swinkr@wustl.edu.