Section 110. Forms

Part V. Forms and Reports

The committee shall promulgate forms to facilitate the acquisition of necessary data and information including the following:

1. A Request for Peer Review that shall include:

a. The name and address of the party requesting review;

b. The name and address of the defending party;

c. The name of the patient;

d. A description of the injury;

e. A description of the medical treatment, services, or costs complained of;

f. Where and when the treatment or services took place;

g. A copy of any other relevant information forming the basis for the request for review.

2. A Notice of Peer Review that shall include:

a. A copy of the request for review;

b. Notice of right of physician, employer, insurer, or counsel, to respond in writing and to appear before the peer review committee at an informal hearing;

c. Notice of requirement that a decision be reached by the peer review committee within 30 days of the informal hearing.

3. A Notice of Informal Hearing that shall include:

a. The date and location of the hearing;

b. Right of physician, employer, insurer, or counsel, to appear before the peer review committee for a period of time not exceeding 20 minutes.

Historical Notes

Derived from VR405-02-02 § 5.1, eff. Jan. 9, 1981; July 16, 1993.

Statutory Authority

§ 65.2-1309 of the Code of Virginia.