Forms & Templates

Resident / Fellow 

• Certificate Replacement Request Form
  
• EPIC Training Registration Instructions & Form
• Graduating/Exit Requirements Form
• Lab Coat Ordering Guide
  Order Form
• Offsite Rotations
  

Health & Benefits

• COBRA Forms
  • Letter
  • Enrollment Form
• Communicable Disease Prevention Certification Form
• Direct Deposit Form
• Extended Leave – Pool Request Form
• House Officer Contract (Sample)
• Leave of Absence Form
• Moonlighting Forms:
  • FY 19-20 ML Form
    
• UHC Life Insurance Beneficiary Form
• UHC Dental Vision Enrollment Form
• UHC Health Enrollment Forms

Reimbursement

• Travel Request Checklist
• Pre-Approval (TAR) Form
• T & E Form

Program / GMEC

• Attestation Statement
• Crisis Management Toolkit
• Fitness for Duty Assessment
  • For Program Directors
  • For Residents/Fellows
• Non-Match Candidate Application
• Candidate Pre-Screening Form
• Offer Letter (Sample)
• Program Letter of Agreement (PLA) 
  
  • JH ACH & Florida Hospital ONLY Template
  • ALL OTHER LOCATIONS Template
• Request for a New Rotation-Assignment
• Scope of Practice Template
• Visiting Residents 
  • Instructions & Approval Form
  • Communicable Disease Prevention Certification Form
• New Program Request Form (GMEC)
• Request For Change in Program Director (GMEC)
• Request for a New Rotation Site (GMEC)
• Resident/Fellow Complement Change Form (GMEC)