Health Law Forms (UT Authentication Required)

Non-Routine PLI Increased DOMESTIC Coverage: Instructions & Application Forms

• Domestic Increased Limits PLI - FACULTY (specific locations, fixed date range) Instructions & Application Form (rev. May 2025)
   
• Domestic Increased Limits PLI - FACULTY (all locations, flexible #days) Instructions & Application Form (revised October 2024)
   
• Domestic Increased Limits PLI - RESIDENTS & FELLOWS Instructions & Application Form (revised May 2025)
   

Non-Routine PLI INTERNATIONAL Coverage: Guidelines & Application Forms

• International IPLI - FACULTY Instructions & Application Form (revised October 2024)
   
• International IPLI - RESIDENTS & FELLOWS Instructions & Application Form (revised October 2024)
   

Volunteer M.D. Guidelines and Sample Letter

• Volunteer M.D. Guidelines and Sample Letter (revised October 2024)
   

Volunteer Activity PLI Request Forms

• Volunteer Activity PLI Request Form - Faculty (revised October 2024)
   
• Volunteer Activity PLI Request Form - Resident (revised October 2024)
   
• Volunteer Activity PLI Request Form - Medical Student (revised October 2024)