UNIVERSITY OF PENNSYLVANIA – SCHOOL OF MEDICINE

Curriculum Vitae

Date: ______

JOHN DOE

Home Address: 3 Oak Lane

Philadelphia, PA 19108

Office Address: 1102 Maloney Building

Hospital of the University of Pennsylvania

Philadelphia, PA 19104-4283

ECFMG#: 0-123-456-7 (provide attachment)

Certificate Date: 01/12/58

If you are not a US citizen or holder of a permanent visa,

please provide the following information and attachments:

Visa Type:

Effective date:

Expiration date:

Education:

Month/Year – Month/Year BS Yale University

Month/Year – Month/Year MD Medical College of Pennsylvania

Month/Year – Month/Year PhD Medical College of Pennsylvania (Physiology)

Postgraduate Training and Fellowship Appointments:

Month/Year – Month/Year Intern in Medicine, Temple Hospital, Philadelphia

Month/Year – Month/Year Resident in Medicine, Graduate Hospital, Philadelphia

Month/Year – Month/Year Fellowship, Pulmonary Diseases,

Philadelphia General Hospital, Philadelphia

Military Service:

Month/Year – Month/Year US Public Health Services, Tuberculosis Control Section,

Philadelphia

Faculty Appointments:

Month/Year – Month/Year Instructor in Medicine, Department of Medicine

University of Pennsylvania, School of Medicine

Month/Year – Month/Year Associate in Medicine, Department of Medicine

University of Pennsylvania, School of Medicine

Month/Year – Month/Year Assistant in Medicine, Department of Medicine

University of Pennsylvania, School of Medicine

Hospital and Administrative Appointments:

Month/Year – Month/Year Assistant Chief of Pulmonary Disease Section, Department of Medicine

University of Pennsylvania, School of Medicine

Month/Year – Month/Year Chief of Pulmonary Function Laboratory, Department of Medicine

University of Pennsylvania, School of Medicine

Month/Year – Month/Year Director of Inhalation Therapy, Department of Medicine

University of Pennsylvania, School of Medicine

Special Certifications:

Year American Board of Internal Medicine

Licensure:

New York and Pennsylvania

Awards, Honors and Membership in Honoary Societies:

Year Alpha Omega Alpha

Year Nobel Prize in Medicine


-2-

Memberships in Professional and Scientific Societies: (Including offices held)

National Societies:

American Federation for Clinical Research (President, Month/Year – Month/Year)

American Heart Association (Member, Committee on Cardiopulmonary Disease Month/Year- Month/Year)

American College of Physicians (Associate, Fellow or Master)

Local Societies:

Philadelphia County Medical Society

Editorial Positions:

Month/Year – Month/Year Editorial Advisory Board, American Journal of Medicine

Guest Editor – Symposium, Treatment of Tuberculosis, 1970)

Month/Year Associate Editor, American Review of Respiratory Diseases

Principal Investigators of Grants: (Past 5 years)

Factors in Respiratory Distress, National Institutes of Health

KI 54996, 1969-1972, $80,000

Academic Committees at the University of Pennsylvania:

Month/Year – Month/Year Member, Admissions Committee

Month/Year – Month/Year Member, Curriculum Committee

Major Teaching and Clinical Responsibilities for the University of Pennsylvania, or University of New Recruit (Current Only):

1.  In charge of Medicine, 200 students at HUP

2.  Attending rounds at HUP, 3 Months/year

3.  Chest Clinic, HUP, 3 months/year

4.  Elective course: Medicine, 842 throughout the year

5.  Supervision of graduate students and post-doctoral students

Lectures by Invitation: (Please list only those outside Philadelphia area for the past 2-3 years)

June 15, 1971 “Bronchial Obstruction” – American Chest Conference, Arizona

October 2, 1971 “Dyspnea” – National Respiratory Association, San Diego, California

Bibliography: (List only material published or in press)

Original papers:

Smith, R.K. Does, J., Brown, L.K.: Pulmonary Functions During Grand Rounds.

Thorax 64:312-318, 1963

Doe, J., Smith, J., Brown, L.K.: Intrapulmonary Sequestration.

American Journal of Medicine 42:134-138, 1963

Abstract: (List only work not yet published)

Smith, R.K. Jones, J. Brown, L.K.: Observations on Lung Compliance During Yoga Exercises.

Amer. Rev. Resp. Dis. 90:146, 1971

Doe, J., smith, J., Brown, L.K.: CO2 Response to Therapy with Positive Pressure Ventilation.

Clinical Research 16:490, 1971

Editorials, Reviews, Chapters:

The Task of Breathing. Chest 43:2-30, 1964.

Chronic Pulmonary Insufficiency (chapter 3) in Smith, J. (Ed.)

Diseases of the Chest, W.B. Saunders, Philadelphia, 1965.

Books:

What I Know About Chest Disease, by J. Doe, University of Pennsylvania Press,

Philadelphia, 1965.