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
• 23-24 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 Matthew.Konjoian@cuanschutz.edu. 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 Action Plans
• 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 23-24- 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 https://www.fsmb.org/step-3 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 not during RAC. If this is not feasible, with 4 months’ advanced notice, the exam can be scheduled during a clinic or ambulatory block. Once your exam has been scheduled, you must notify Mary Meadows at Mary.Meadows@cuanschutz.edu and your rotation director of your scheduled dates. A copy of your USMLE score needs to be provided to Mary Meadows.

Please visit https://www.fsmb.orgstep-3​ for more information on how 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. Once the application is submitted, all that is needed to complete the Step 3 application is the Certification of Identity form

Submit USMLE Certificate of Identity form (hard copies) with photo attached to Mary Meadows in the Housestaff office to notarize.  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 (usmle@fsmb.org) to determine your application status. They will only provide the status information to the you, the physician, and not a third party.