Resident / Fellow

• Certificate Replacement Request Form
• Graduating/Exit Requirements Form

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 22-23-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)
• Offsite Rotations
• Program Letter of Agreement (PLA) 
  
  • PLA Template
• 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 (ACGME Programs)
• Request for Change in Program Director (non-ACGME Programs)
• Resident/Fellow Complement Change Form (GMEC)
• Request for an Exceptional Applicant (GMEC)
• Request for a Rotation, Assignment, or Site (GMEC)

Health Insurance Machine Readable Files

• UnitedHealthcare creates and publishes the Transparency in Coverage Machine-Readable Files on behalf of UMSA/USF MCOM
• To link to the Machine-Readable Files, please click on the URL provided: https://transparency-in-coverage.uhc.com