FORMS 

PROGRAM FORMS

• Observation evaluations are now done through MedHub, you may self initiate one. (Prelims must contact Jefferson to queue up this evaluation).
• Preceptor & Resident Self-Evaluation
• Continuity Clinic forms
• PC Research Approval Form
• Preceptorship or Special Rotations Request Form
• Resident Research Elective Approval Form
• 25-26 AY Request for Travel Funds to Present Research - If a Resident has been invited to present at a meeting or conference, it is expected that a research grant of the resident's faculty sponsor will cover the resident's expenses. The next source of funding is a grant of $1500 from the GME Educational Fund allowance. To receive this funding, please provide a copy of the invitation to present along with this form to Jefferson Velasco. In order to be reimbursed, travel arrangements must be made through our office. 
  • Airfare MUST be booked through Matthew per procurement policy.

POLICY FORMS

• 2022-2023 APE ERAS Addition
• Missed Deadline Policy
• INTERNAL MEDICINE RESIDENCY PROGRAM MANUAL 23-24
• Jeopardy Guidelines

MOST COMMONLY USED FORMS:

• DORA L3 R3 Training Verification 2023-2024 - Please fill out SECTION ONE of this form and submit hard copy to Mary Meadows in the Housestaff office for completion. A request for proof of malpractice insurance will be sent on your behalf. 
• DORA (L6) Practice History - This form is prefilled for you.  Print, sign and add to your application. 

Please visit here for more information on how to apply for the USMLE Step 3 exam.

USMLE Step 3 must be completed in PGY1 year.

• USMLE Step 3 examinations are to be scheduled during an Elective rotation and are not permitted to be taken during Inpatient or RAC rotations.  If taking the exam during an elective rotation is not feasible, with 3-4 months advanced notice, the exam can be scheduled during a clinic or ambulatory block.  When scheduling, please try to avoid scheduling the exam during your ½ day add-back clinic.  Once your exam has been scheduled, you must notify [email protected], and notify your rotation director and/or preceptor of your scheduled dates.  It is your responsibility to inform your rotation well in advance of your scheduled Step 3 dates.  
  

• Please visit the USMLE/FSMB webpage at https://www.fsmb.org/step-3​ to apply for the USMLE Step 3 exam.
  

• To apply for the Step 3 all physicians are required to create an account, complete the online application, and pay the fees. The Certification of Identity (CID) must be completed.  FSMB provides the option for Identity Verification with Docusign free online.  This is a new feature on the FSMB site.  If you are unable to process your Identity Verification through the site, the traditional option is still available to complete the CID form, (hard copies) with photo attached and provide to Mary Meadows in the Housestaff office to notarize.  Notarizations must be done in person.  The Hub on the first floor of Academic Office One (AO1) can also serve as a notary for you. 
  

• If you are not contacted about your application within ten business days, contact the FSMB office ([email protected]) to determine your application status. They will only provide the status information to the you, the physician, and not a third party.