Residencies

Residency Training License Forms

Cynthia Armstrong — Wed, 11 Nov 2009 21:20:24 GMT

Residency Training License Forms Forms Residency Training License Forms If you have difficulty downloading any of the forms within the Residency Training License Application, the forms below are being provided here for your convenience. Applicants Oath Application For Resident Training Li

WF Coversheet

Cynthia Armstrong — Tue, 10 Nov 2009 20:23:40 GMT

APPLICATION FOR RESIDENT TRAINING LICENSE Wake Forest University Baptist Medical Center Start Date: Name: Credentials House Staff NCMB 1. Completed Application ( ) ( ) 2. Name Chan ge Docs ( ) ( ) 3. Med School

Transfer Form

Cynthia Armstrong — Tue, 10 Nov 2009 20:23:04 GMT

North Carolina Medical Board Resident Training License Transfer Form A physician transferring from one North Carolina residency program to another North Carolina residency program must submit an appointment letter from the institution he/she is entering. The appointment letter must be written by the chief of se

RT Physician Reference Form

Cynthia Armstrong — Tue, 10 Nov 2009 20:22:29 GMT

PHYSICIAN REFERENCE FORM North Carolina Medical Board TO APPLICANT: The North Carolina Medical Board requests completion of TWO reference forms. These forms must be sent from the reference sources directly to the applicant in sealed envelopes with the s ources signature affixed across the seal. Submit the two r

Rotation Appointment Form

Cynthia Armstrong — Tue, 10 Nov 2009 20:21:36 GMT

North Carolina Medical Board Rotation Appointment Form If an appointment is to complete a rotation in North Carolina as part of a program an applicant is enrolled in outside of North Carolina, the following information is required from the chairman of the department at the applicant s current location.

Medical School Certification Form B

Cynthia Armstrong — Tue, 10 Nov 2009 20:21:01 GMT

NORTH CAROLINA MEDICAL BOARD MEDICAL SCHOOL CERTIFICATION FORM (B) Form (B) is to be completed by physicians who have graduated and received a medical degree. The North Carolina Medical Board requires you complete this form. Please return to me at the following address:

Medical School Certification Form A

Cynthia Armstrong — Tue, 10 Nov 2009 20:20:21 GMT

NORTH CAROLINA MEDICAL BOARD MEDICAL SCHOOL CERTIFICATION FORM (A) Form (A) is to be completed by fourth year medical students who have completed the requirements for the MD/DO degree, but have not received the degree. The North Carolina Medical Board r equires you complete this form. Please return to me at

License Verification Form

Cynthia Armstrong — Tue, 10 Nov 2009 20:19:34 GMT

LICENSURE VERIFICATION FROM OTHER STATES Applicant: If you have ever held a license in one of the following professions: medical (other than a training license), dental, nursing (RN), and/or law, complete the top portion of this form and forward one copy to each licensing board in the state(s) where you have held

Fifth Pathway Verification Form

Cynthia Armstrong — Tue, 10 Nov 2009 20:18:47 GMT

VERIFICATION OF FIFTH PATHYWAY North Carolina Medical Board PO Box 20007 Raleigh, NC 27619 Instructions to the applicant: Complete the following section of this form and forward to all Fifth Pathway program(s) in which you have participated. Make copies of the form as necessary. Request the Program Director

Claim Form

Cynthia Armstrong — Tue, 10 Nov 2009 20:16:44 GMT

CLAIM INFORMATION FORM NORTH CAROLINA MEDICAL BOARD Please attach a PHOTOCOPY of the PLAINTIFF S COMPLAINT AND SETTLEMENT ORDER, if there is one. The applicant must complete this form for each liability or malpractice claim of which they are aware. P lease make as many photocopies of this form as you need.

Authority for Release Form

Cynthia Armstrong — Tue, 10 Nov 2009 20:16:14 GMT

AUTHORITY FOR RELEASE OF INFORMATION State and Federal Record Check I authorize the North Carolina Department of Justice through the State Bureau of Investigation, Division of Support Services to perform a fingerprint search of the State s criminal hist ory record file and a fingerprint search of the Federal Bu

Application

Cynthia Armstrong — Tue, 10 Nov 2009 20:15:31 GMT

APPLICATION FOR RESIDENT TRAINING LICENSE North Carolina Medical Board Application for issuance of a license to practice medicine is effective for a period of 1 YEAR from the date application is notarized. All changes in the answers to these questio ns must be reported to the Board. North Carolina Gen

Applicants Oath

Cynthia Armstrong — Tue, 10 Nov 2009 20:01:24 GMT

APPLICANT S OATH I hereby certify under oath that I am the person named in this application for a license to practice medicine in the State of North Carolina, that all statements I have made herein are true, and that I am the person named in the various f orms and credentials furnished to this Board with my applicat

Before Arrival

Star Lee — Fri, 06 Nov 2009 21:21:30 GMT

Before Arrival

Joycelyn Johnson — Fri, 06 Nov 2009 21:00:04 GMT

Orientation Schedule

Joycelyn Johnson — Fri, 06 Nov 2009 20:53:37 GMT

Before ArrivalOrientation Schedule

Residency Information

Star Lee — Thu, 05 Nov 2009 21:11:40 GMT

The North Carolina Baptist Hospital offers first-year appointments to comply with the recommendations of the Accreditation Council on Graduate Medical Education.

Current House Staff

Joycelyn Johnson — Fri, 06 Nov 2009 15:59:02 GMT

Current House Staff

On-Call Room

Joycelyn Johnson — Thu, 05 Nov 2009 18:40:37 GMT

A to Z List of Residency Programs

Mark Flaherty — Mon, 16 Nov 2009 12:58:44 GMT

A list of residency programs by department

RoutingforPayAdvance

Star Lee — Wed, 30 Sep 2009 13:52:23 GMT

Routing for Pay Advance ________ Ala Jo Koonts ________ Greg Bray ________ Shelley LIndsay Request for Advance in Pay for Incoming Residents I, ______________________________, request an advance in my contract salary for $_____________. I understand that this amount will not exceed $2,000. I agree to repay this advance

ncbhhss32

Star Lee — Wed, 30 Sep 2009 13:52:20 GMT

NCBH-HSS-32 NORTH CAROLINA BAPTIST HOSPITALS, INC. POLICY AND PROCEDURE From: Physician Services Approved by: _________________________________ Director, Physician Services _________________________________ Chair, Graduate Medical Education Committee SUBJECT: ON-CALL ROOM ACCOMMODATIONS I. POLICY It is the policy of No

NCBHHSS31

Star Lee — Wed, 30 Sep 2009 13:52:18 GMT

PPB-NCBH-HSS-31 Effective Date: 06/30/2007 Page 1 of 2 NORTH CAROLINA BAPTIST HOSPITALS, INC. POLICY AND PROCEDURE BULLENTIN PREPARED BY: Medical Staff Services CONTACT PERSON: Director, Medical Staff Services SUBJECT: On-Call Meals for House Staff I. POLICY It is the policy of North Carolina Baptist Hospitals, Inc. to

Policies

Internal Administrator — Fri, 10 Jul 2009 12:44:44 GMT

Policies

Rotating Residents

Star Lee — Thu, 10 Sep 2009 18:07:05 GMT

All residents coming to Wake Forest University Baptist Medical Center to do a rotation must provide the House Staff Office with the appropriate documentation.

Incoming House Staff

Joycelyn Johnson — Tue, 10 Nov 2009 18:54:18 GMT

Wake Forest University School of Medicine has provided general information regarding residency programs.

Checklist for Incoming House Staff

Joycelyn Johnson — Thu, 05 Nov 2009 19:10:00 GMT

Incoming residents should ensure that all application requirements have been met prior to orientation.

Prospective House Staff

Star Lee — Wed, 28 Oct 2009 13:19:50 GMT

Wake Forest University School of Medicine has provided general information for prospective residents.

Benefits

Internal Administrator — Thu, 05 Nov 2009 18:45:04 GMT

Benefits

Resident Pay Advance

Internal Administrator — Thu, 09 Jul 2009 01:24:15 GMT

Training License

Internal Administrator — Thu, 09 Jul 2009 01:24:15 GMT

On-Call Meals

Internal Administrator — Thu, 09 Jul 2009 01:24:14 GMT

On-Call Rooms

Internal Administrator — Thu, 09 Jul 2009 01:24:14 GMT

residency

Internal Administrator — Thu, 09 Jul 2009 01:23:49 GMT