If you are interested in rotating in the Department of Neurology Residency Program:
1. You must contact the director of the program you are interested in doing a rotation on and receive permission for the rotation.
2. Go to the UCSF GME website (listed below), download, complete and submit the appointment forms required to complete the rotation.
3. Please note you will not be able to work with patients until these forms have been cleared with our Graduate Medical Education (GME) office. This process can take up to 6 weeks once all forms have been received by the GME office.
Forms: http://www.medschool.ucsf.edu/gme/coordinators/appointment/ElectiveShortTermAppt/ElecIndApptForms.aspx
Elective/ Short-Term Individual Appointment Forms
The appointment forms below have been designed to be used as electronic forms. In order to be able to type in the forms, tab between fields, save and print, your computer must have Adobe Acrobat 7.0. These forms are printable without version 7.0.
Forms description: http://www.medschool.ucsf.edu/gme/pdf/FormsElectiveNewAppyDescri.pdf
CHECKLIST AND COVER SHEET The Checklist and Cover Sheet for new elective/short-term appointments must be completed and on the top of all appointment packets submitted to the GME Office.
APPLICATION FOR ELECTIVE The Application for Elective must be complete and signed by both the UCSF Program Director and the trainee’s home Program Director. Be sure to include the program code (which consists of four to five letters) and the percent time that the rotator will be spending in various locations/rotations/departments.
DATA GATHERING DOCUMENT The Data Gathering Document is a two page form that asks for basic information about the trainee as well as rotation and program information. This form must be complete and signed by the Program Director of the program here at UCSF (not the trainee’s home institution). This form is important since the GME Office will be entering the information in RFS, not the Department.
PROOF OF MEDICAL MALPRACTICE COVERAGE All short-term, elective rotators must provide proof of medical malpractice coverage of a minimum of $1,000,000 per occurrence. This proof may be in the form of a certificate or letter from an authorized individual at the trainee’s home institution stating details of the coverage as well as the provider of the coverage. The home institution must provide the medical malpractice coverage as well as pay the rotator’s salary and benefits while the trainee is at UCSF.
CALIFORNIA MEDICAL LICENSE OR POST-GRADUATE TRAINING REGISTRATION FORM California law mandates that all physicians practicing or training in the state, including residents and fellows, be licensed after two years of ACGME training for US and Canadian medical graduates or three years of ACGME training for foreign medical graduates. If a physician from an institution in the state of California is unlicensed, he/she must complete a Post-Graduate Training Registration Form, that must be sent to the Board by the UCSF Program Coordinator, alerting the Board that he/she is training at UCSF without a license. California licensure is not required for physicians training in another state that would like to come do a short-term, elective rotation, even if the person qualifies for California licensure. A physician from another state may train at an institution in the state of California for up to 90 days without a license. Therefore, either a copy of the trainee’s CA medical license or Post-Graduate Training Registration Form must be submitted with the appointment packet. A print-out of the trainee’s license from the Medical Board’s website will be accepted (http://www.medbd.ca.gov).
HEALTH STATEMENT AND PROOF OF VACCINATIONS All residents and fellows rotating at UCSF must provide proof of measles, mumps, rubella, and varicella vaccinations and/or titers, as well as proof of hepatitis B vaccination or titer or signed vaccination declination form. This proof may be provided on forms form the trainee’s home institution or health
1/20/2006
