Peer Review Request Form

This request for review will initiate a confidential peer review proceeding by the Maine Medical Association – Center for Quality Improvement’s External Peer Review Program in accordance with the current edition of the Program Policy, Guidelines and Fee Schedule. The proceeding and its participants are protected by the peer review provisions of Maine law, particularly 32 M.R.S.A. §§3293 and 3296, and portions of 24 M.R.S.A., Chapter 21, the Maine Health Security Act.

PLEASE NOTE:

• Actions and decisions made regarding credentialing of the reviewed practitioner(s) are at the sole discretion of the requesting organization.
• A $250 fee may be charged to the requesting organization for reviews cancelled after the reviewing team and date have been coordinated.