Ken Schnauder, Executive Director

Tel: (225) 362-5262
Fax: (225) 362-5265
Email: Ken.Schnauder@la.gov

Physical Address:
8225 Florida Blvd., 2nd Floor
Baton Rouge, Louisiana 70806
1-866-469-9555
225-362-5400

Mailing Address:
P.O. Box 3718
Baton Rouge, Louisiana 70821

Get A Game Plan Louisiana Recovery Authority LaTrac

Applications
Click on the application name to view/print any application.
ALL NEW APPLICATIONS
A signed application is needed. Please print out the signature page, sign it and submit it to our office.
PRIMARY INSURANCE
Forms for MDs & Advanced RNs with Primary Insurance
PCF1Application for MDs & Advanced RNs
PCF1RRenewal Application for MDs & Advanced RNs
PCF10Procedure Questionnaire for those with "minor" or "major" surgery designation

Forms for Dentists with Primary Insurance
PCF2Application for Dentists Oral Surgeons
PCF2RRenewal Application for Dentists Oral Surgeons
Forms for Hospitals and Nursing Homes with Primary Insurance
PCF3Application for Hospitals and Nursing Homes
PCF3RRenewal Application for Hospitals and Nursing Homes
Forms for Non-MDs with Primary Insurance (Chiropractors, Optometrists, Pharmacists, Physical Therapists, Psychologists, etc. )
PCF4Application for Non-MDs with Primary Insurance -- Chiropractors, Optometrists, Pharmacists, Physical Therapists, Psychologists, etc.
PCF4RRenewal Application for Non-MDs with Primary Insurance -- Chiropractors, Optometrists, Pharmacists, Physical Therapists, Psychologists, etc.
Forms for FTEs, Locum Tenens, Clinics, ER Groups and Surgical Centers with Primary Insurance
PCF5Application for FTEs, Locum Tenens, Clinics, ER Groups and Surgical Centers
PCF5RRenewal Application for FTEs, Locum Tenens, Clinics, ER Groups and Surgical Centers
Additional Forms As Needed for Any of the Above Health Care Providers
PCF9Application for Corporations
PCF11Questionnaire for those w/limited or no practice in LA
PCF12Part Time Questionnaire
PCF14Application for Management Companies
SELF-INSURANCE
Forms for Healthcare Professionals with Self Insurance
PCF6Application for Healthcare Professional
PCF6RRenewal Application for Healthcare Professional
Forms for Hospitals with Self Insurance
PCF7Institutional Health Care Provider Application
Forms for Nursing Homes and Assisted Living Facilities with Self Insurance
PCF8Nursing Home and Assisted Living Facility Application
Forms for FTEs, Locum Tenens, Clinics, ER Groups and Surgical Centers with Self Insurance
PCF16Application for FTEs, Locum Tenens, Clinics, ER Groups and Surgical Centers
Additional Forms As Needed for Any of the Above Health Care Providers
PCF9Application for Corporations
PCF11Questionnaire for those w/limited or no practice in LA
PCF12Part Time Questionnaire
PCF13Pledge Agreement for Self Insured Providers
PCF14Application for Management Companies
Sample Letter of Credit