Your contract with the program to which you have recently been appointed will be sent to you at the address provided on your application. Once you receive the Agreement, please review carefully and sign the document. There are two (2) pages which require signatures, be sure to sign in both places. Return this document no later than May 1, 2007 to:
House Staff Office
Medical Center Blvd.
Winston-Salem, N.C. 27157
Attention: Diane Hartley
You must obtain a Residency Training License prior to beginning your training program. The North Carolina Board of Medical Examiners has made the application available on-line. Please go to http://www.ncmedboard.org/ . Click on "For Physicians" at the top of the page. The menu for licensing will be listed on the left-hand side of the page. Select "Residency Training License Application". Complete the parts on-line that you can. Print the documents that need to be printed and mailed. The Board has provided a section "Residency Training License Status", where you may go in after the application has been completed and check the status of your own application. Your on-line application will be electronically sent to the House Staff Office at this institution. Your application will remain with the House Staff Office until all paper credentials and documents arrive from the sources in which you have requested information. Once all required documentation is received, the House Staff Office will electronically submit the on-line application to the Board and mail the paper credentials and documents for process and review.
If you have difficulty downloading any of the forms within the Residency Training License Application, the forms are being provided here for your convenience.
The House Staff Office will coordinate the application process and act as liaison between you, the applicant, and the North Carolina Medical Board. Unless otherwise indicated during the application process, all paper credentials and documents are to be sent directly to Diane Hartley in the House Staff Office. Please do not contact the North Carolina Medical Board. If you have any questions or concerns regarding the application process, please direct them to the House Staff Office.
ALL Residency Training License Applications must be submitted to the House Staff Office. These applications should be complete. If your school is one that does not complete the Medical School Certification Form until after graduation, please send your application in without that form and it can be reviewed and held for issuing pending that one form. Please work to have all the other forms and documentation necessary by that time. The license is absolutely necessary in order for you to begin training. Put this first on your list of things to do. Delays in licenses have caused many residents, delays in beginning their training. The importance of this application cannot be stressed enough. Do it timely, completely and provide all necessary documentation.
Note: If you have not yet graduated from medical school, your school must complete “Medical School Certification Form A”. If you have graduated already Form B must be completed. If you turn your form into your school and they are not going to process until after graduation, be sure you give them Form B. The Board will not accept the wrong form. Completion of the wrong form has slowed down the licensing process for many entering a training program.
If you are entering a second year of training or above, you may elect to apply for the Residency Training License or a Full N.C. License. The training license is all that is required. The application for full medical license can also be obtained at the N.C. Medical Board’s website. If you elect to obtain a full license, all questions and concerns regarding that application must be addressed directly to the Board, not our office.
When entering a residency training program and obtaining a residency training license, the institution will issue you a DEA number to use within the parameters of your training program. If you obtain a Full North Carolina Licensure and plan to use that license to “Moonlight”, you must apply for and obtain your own DEA number. You can obtain an application for a DEA number on their website www.deadiversion.usdoj.gov/online_forms.htm.
The North Carolina Medical Board, as part of their licensure process, requires a complete criminal background check on all applicants. The release form for your signature is included with the application that you will print from the “Residency Training License” section of the webpage. You will need to obtain 2 sets of fingerprints. A card for the fingerprints will be included in the package being mailed to you containing your contract. The fingerprint card needs to be returned with the license application. Important: These fingerprints must be completed by a professional, i.e. Security Office at your institution, local Police Department or Sheriff Department. Do not attempt to do your own prints.
In addition to the background check completed by the Medical Board, North Carolina Baptist Hospital obtains their own background check on all new employees. Please complete the online Criminal Background Check form. Please note: if you lived in any of the states listed on the form additional information and/or additional finger prints may be required.
Once you have matched or have been accepted into a residency program, please complete the New House Staff Information form. Once completed click on the “submit” button and the information will automatically be transferred to the House Staff Office.
Send copies of your ACLS/BCLS certifications to the House Staff Office. You can send these along with you Agreement (Contract). If you are not certified at this time, you must obtain certification prior to beginning your program. You should get this certification before arriving at this institution, but if it is impossible for you to get the training, there will be ACLS/BCLS Training during New House Officer Orientation, however for a very limited number. If you are unable to obtain the certification please complete the registration form and email it directly to Life Support Education.
All incoming house staff are required to have an Initial Health and Drug Screening provided by the institution’s Employee Health Services. You cannot begin your training program until this requirement is met. Please see the Employee Health Services page for further information.
Foreign Medical Graduates
If you are a foreign medical graduate you must ensure that the appropriate documents are in our office relative to your visa. If not a naturalized citizen or a green card holder, you must enter a residency training program at Wake Forest University Baptist Medical Center on a J-1 visa. If you are already on a J-1 visa, you need to submit the paperwork to ECFMG (Education Commission for Foreign Medical Graduates) for a Continuation of Sponsorship and have your training institution transferred to this institution. If you have never applied to ECFMG for sponsorship before, you need to complete the paperwork for Initial Sponsorship with ECFMG Both of these documents can be obtained at the ECFMG website. Please be sure and begin this process as soon as possible, as it normally takes 8 to 12 weeks and can take longer. If this documentation is not completed prior to July 1, you can not begin your training program.
Electronic Record Training
Please watch these online education videos prior to orientation. Hands-on classes will occur during orientation. These videos are a prerequisite to the class. Access to our electronic records cannot be provided until this on line training has been completed.
Mandatory Corporate Compliance
Corporate Compliance Training is required training for all hospital employees. Click on 2007 Annual Compliance and HIPAA Training, review the entire module.
Mandatory Bloodborne Pathogen Education/Infection Control Training
Infection Control Training is required training for all hospital employees. Click on NCBH 2007 Bloodborne Pathogen Education/Infection Control Annual Training, review the entire module.
Hospital Confidentiality Agreement
Read, sign and submit the Hospital Confidentiality Agreement. The way you sign is by typing in your name, department (this is the department you will actually be working in), and department number (the department number for all house staff is 795).
Values in Action
Employees are expected to comply with all applicable laws, regulations and the policies of The North Carolina Baptist Hospitals, Incorporated and Subsidiary Organizations and to act with integrity in all situations. Values in Action is provided as a practical guide to handling important issues for employees. Although it cannot cover every situation, it should be used as a resource to provide general guidance.
Medical Records
All incoming house staff must review the material in the Medical Records, then print, sign and return page 4 site prior to entering their training program.
Employment Eligibility Verification (Form I-9)
All U.S. employers are responsible for completion and retention of Form 1-9 for each individual they hire for employment in the United States. This includes citizens and noncitizens. On the form, the employer must verify the employment eligibility and identity documents presented by the employee and record the document information on the Form I-9. Acceptable documents are listed on the back of the form, and detailed below under "Special Instructions." Please complete the Employment Eligibility Verification Form and then print out the completed form. Please bring the completed form and required identification documentation to Human Resources when you come to have your ID badge made prior to Orientation.
Payroll Direct Deposit
All employees are required to have their paycheck directly deposited into a bank account. Please print and complete the Payroll Direct Deposit Form. Please be sure to attach the appropriate banking information (a blank deposit slip or voided check) so there will be no delay in your receiving your pay. Please mail the completed form into the office with your license application or other materials you may send.
Federal and N.C. State Withholding Tax
Prior to beginning your training program you must provide the hospital with federal and N.C. state tax withholding information. Please download, print and complete the forms provided below. Please mail the completed forms into the office with your license application or other materials you may send. Remember you must have these documents completed and turned in prior to beginning your training program.
Orientation Schedule/Agenda
See the Orientation page.
Review the list below and make sure you have completed or taken the appropriate steps to complete all the requirements listed. If not, please complete prior to orientation.
- Sign and return Residency Training Agreement (Contract).
Deadline: April 23, 2008
- Complete and return Residency Training License Application, including fingerprint cards. Deadline: April 30, 2008.
- Complete NCBH Background Check Form: Deadline: April 30, 2008.
- Submit House Staff Information Sheet: Deadline: April 30, 2008.
- Submit copies of ACLS/BCLS Certification or register for appropriate class: Deadline: April 30, 2008.
- Submit Demographic Form to Employee Health Services and make appointment for initial screening. Print immunization Form to compile records to provide to Employee Health: Deadline: April 30, 2008.
- Review Medical Legal Survival: A Risk Management Guide for Physicians: Deadline: June 1, 2008
- Complete Electronic Record Training: prior to class.
- Complete and submit 2007 Annual Compliance and HIPAA Training: Deadline: June 7, 2008.
- Complete and submit NCBH 2007 Bloodborne Pathogen Education/Infection Control Annual Training: Deadline: June 7, 2008.
- Review, sign, and submit Confidentiality Agreement: Deadline: June 1, 2008.
- Review Values in Action: Deadline: June 1, 2008.
- Review Medical Records, then print, sign and return page 4: Deadline: June 1, 2008.
- Complete and return Employment Eligibility Verification (Form I-9): Deadline: June 1, 2008.
- Complete and return Payroll Direct Deposit Form: Deadline: June 1, 2008.
- Complete Federal and N.C. State Withholding Tax : Deadline: Prior to beginnning training.
- ***Foreign Medical Graduates*** ECFMG Sponsorship: Deadline to begin process: April 2, 2008.
Upon Completion of the checklist please submit validation to the House Staff Office, that you have completed all the requirements.
Please contact the House Staff Office with any questions or concerns.