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NICA :: OBGYN'S - Participating OBGYN'S
NICA :: OBGYN'S - Participating - Forms & Brochures
NICA :: OBGYN'S - Participating - Procedures
NICA :: OBGYN'S - Participating - Links
NICA :: OBGYN'S - Participating - Exemptions
NICA :: OBGYN'S - Non-Participating OBGYN'S
Other Physicians

Participating OBGYN'S: Forms & Brochures

Notice brochures and acknowledgment forms are important tools in maintaining protection under the NICA program. In order to comply with statutory requirements, notice must be provided in a timely manner. It is also strongly recommended that all acknowledgment forms signed by the patient, the participating physician, and any hospital are kept on file as evidence of compliance.

Brochures for providing notice and examples of forms for documenting acknowledgment by patients, participating physicians, and hospitals are provided in this section of the NICA website.

NICA suggests that each participating physician and hospital develop a system to document the date on which a patient is given notice of the physician's participation in the NICA plan.

Physicians and hospitals should rely upon their own legal counsel's interpretation of Section 776.316, Florida Statutes, with regard to providing notice and timeliness of notice, and actions to take in the event a patient refuses to acknowledge receipt of this notice.

Forms in other languages, including Spanish, Creole, and 10 other languages are available by calling NICA. In the future, forms will be provided in additional languages on request to help NICA participants follow statutory requirements.

Additional forms which will assist you with office procedures are available from the American College of Obstetricians and Gynecologists (ACOG) web site at

  • Welcome.pdf
  • Don't settle.pdf
  • Downloadable Notice Summary
  • Downloadable Acknowledgment form
  • Downloadable Acknowledgment form (Spanish)
  • Downloadable Brochure Request form
  • Patient Procedure Checklist

  • Brochures Forms are in 'PDF' format. If you do not have Adobe Acrobat Reader, click here to get it.

    All information on this website is intended for general informational purposes only and should not be considered legally binding, legal advice, nor substitute for obtaining legal advice from competent legal counsel. Although reasonable efforts are made to keep information on this site accurate, no guarantee is made as to its accuracy.

    � 2006 The Florida Birth-Related Neurological Injury Compensation Association