North Charleston + (843) 225-1115
West Ashley + (843) 225-3345
In making this application:
I agree to participate
I hold the Clinic and its representatives free of all liability for such actions.
I hereby release from liability DCC and all its representatives for their acts performed while evalua- ting my application, credentials and qualifications.
I hereby release from any liability any and all individuals and organizations that provide information to DCC or its representatives concerning my professional competence, character, ethics, and other qualifications for employment and/or privileges and I hereby consent to the release of such infor- mation.
As applicable, I hereby accept that I will abide by the requirements for medical malpractice coverage for the Federal Tort Claims Act. I will cooperate fully in all measures to improve quality and reduce risks, and with any investigations and defense of liability claims.
I understand that I have the burden of producing adequate information for the proper evaluation of my professional competence, character, ethics and other qualifications, and for resolving any doubts about such qualifications. I fully understand that any misstatements or omissions in the application constitute cause for denial or termination of privileges and/or employment. All information submitted by me in the application is true to the best of my knowledge.