2012 - 2013 New Residents / Fellows

Office of Graduate Medical Education

FORMS ARE DUE NO LATER THAN APRIL 13, 2012

DOCUMENTS / INFORMATION / INSTRUCTIONS
Employment Contract
Resident Manual
Current CV / This has been e-mailed to you; please sign, date and return all pages via U.S. Mail.
By signing your contract, you acknowledge that you have been given access to the Resident Manual.
Provide an updated CV including your GWU Residency/Fellowship program timeframe. Return by E-mail, U.S. Mail or Fax.
Required Training Modules / All new GW residents and fellows are required to complete the following six training modules and post tests on the E*Value website: OSHA, HIPAA, Joint Commission Patient Safety Training, Restraints, Medication Reconciliation and Regulatory Compliance.
The E*Value system will notify you by email with instructions for accessing the site and completing this training. If you have any difficulty in accessing the website, or if your email address changes, please contact Lisa Turner, GME Database Manager, either by email or by phone 202-994-4870 for assistance.
All modules must be completed and passed prior to hire date.
Lab Coat Form / Please complete. Return by E-mail or Fax IMMEDIATELY
Release Form / Please sign. Return by Fax or U.S. Mail
Pre-Placement Physical Exam / The District of Columbia requires that individuals involved in patient care have annual health clearances. You must have your initial health clearance prior to beginning work. Please see your health care provider, have the forms completed and signed, attach all necessary records and return as instructed on the form. The health clearance must be completed before you begin your training. Residents and fellows who wish to have their health clearances done at GW should call the phone number on the form and make an appointment with Employee Health Services before orientation. Do not schedule your appointment during the time you are scheduled to attend orientation.
GW Hospital Network Access Form (OPUS)
Issues/questions with this form only contact the helpdesk at 202-715-4955 /
1.Complete the Online Training Module for your program:
a.Emergency Medicine Physicians have a specific module
b.Inpatient Physicians module
(any program except EMed, Radiology & Pathology completes this module)
c.Radiology & Pathology Residents: Do not have an online modulel; See #2 below
2.Read the Provider Forms Instructions, complete forms as appropriate. Due by April 13, 2012
Resident Profile / Complete Form
Return by E-mail or Fax.
D.C. Medical Acknowledgement Form / Sign to acknowledge that you understand the requirements of the D.C. Board of Medicine for Resident/Fellow licensure.
Return by U.S.mail or Fax.
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E / Residents NOT Required to obtain a Full DC License
Residents/Fellows REQUIRED to obtain a Full D.C. License. / The District of Columbia Board of Medicine has requested a change to the way postgraduate physicians in training are regulated by the Board. The legislative bill is currently under congressional review. The GME office will notify all residents via email with further instructions.
Click here for application. Please follow the DC Board’s instructions:
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S / Maryland Board of Medicine
(Fees paid by GME) / The following programs only
Clinical Cardiac Electrophysiology, Emergency Medicine
Interventional Cardiology, Ob/Gyn, Otolaryngology, Surgery and Neurological Surgery
Return by U.S. mail.
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E / Virginia Board of Medicine
(Fees paid by GME) / The following programs only
Anesthesiology (PGY 1 only); Cardiology, Emergency Medicine, Gastroenterology, Geriatrics, Infectious Disease, Internal Medicine, Nephrology, Neurosurgery, Ob/Gyn, Otolaryngology, Hospice & Palliative Medicine, Psychiatry, Psychosomatic Medicine, Surgery, Urology
Return by U.S. mail.
NPI Number / -- Click the link; apply as anindividual and not as an institution.
-- List the following address for your contact information:
The GW Medical Faculty Associates
2150 Pennsylvania Avenue, NW
Washington, DC 20037
202-741-3000
  • A Healthcare Provider Taxonomy Code for classifying medical students, and interns and residents who are not yet licensed (based on state licensing requirements), is available for use: Student, Health Care (390200000X).
  • Set up a username and password that you will remember; you will need to access your account to update within 30 days of any changes in taxonomy code, practice address, name change, etc.
Forward the email with your NPI number from NPPES to your program director and list it on the Resident/Fellow Profile form
Disability Insurance Application / Complete Form Return by US mail or Fax.
Long Term Disability 1 Year Waiver Form / Your former employer is to complete the bottom section and send back to you. Please then forward the completed form to the Benefits Department (see bottom of waiver form for address)
B / Human Resources Information Systems (HRIS): / Click the link, complete and submit the form.
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E / Employee Benefits / The University Benefits Office staff will attend Orientation to explain your benefits to you, provide an opportunity to ask questions, and assist you with completing online enrollment following the Orientation presentation. A detailed description of benefits can be found at the following website: Please review this information carefully so that you are prepared to ask appropriate questions at Orientation.
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I / Employment Verification - I-9 Clearance / You will be required to complete the I-9 form at orientation. You must bring documents that establish both identity and employment eligibility. You must bring the original proofs of identify and/or employment authorization and a copy of each to give to the I-9 processor. All documents must be unexpired. Expired documents cannot be accepted:
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S / Parking Benefits / GW residents and fellows receive free parking during working hours at GW. Vehicles parked on GW property must be registered and a valid parking sticker must be displayed. You may register more than one vehicle, but only one vehicle at a time may be parked in a University garage. University Parking office staff will attend orientation to distribute parking assignments and stickers. You will be issued a GW Identification badge and a hospital ID badge, however, you will need to bring your vehicle registration with you to orientation.