Affiliation & Rotator Agreements/Policies- GME

Guide to Help Annotate the PLA for Your ACGME Site Visit

Letter of Agreement for Electives

Flowchart for New and Renewing Affiliations

Guide for Selecting the Correct Affiliation Template

Request for Affiliation

• EXAMPLE of Completed Form

Non-Standard Affiliation Agreements

• Non-Standard Affiliation Agreement Template with reimbursement
• Non-Standard Affiliation Agreement Template without reimbursement
• Non-Standard Affiliation Agreement Template with reimbursement- MIDTOWN
• Non-Standard Affiliation Agreement Template without reimbursement- MIDTOWN

Johns Hopkins University/Hospital

• Johns Hopkins University/Johns Hopkins Hospital
  (Use for UMMC's residents/fellows rotating AT Hopkins)
• AAMC Uniform Terms and Conditions

Mercy Affiliation Agreements

• Mercy Affiliation Agreement Template (Emergency Medicine/Pediatrics/Anesthesiology/Dermatology) with reimbursement
• Mercy Affiliation Agreement Template (Emergency Medicine/Pediatrics/Anesthesiology/Dermatology) without reimbursement
• Mercy Affiliation Agreement Template (Other) with reimbursement
• Mercy Affiliation Agreement Template (Other) without reimbursement

State Institution Affiliation Agreements

• State Institution Affiliation Agreement Template with reimbursement
• State Institution Affiliation Agreement Template without reimbursement

VA Affiliation Agreements (use same agreement with or without reimbursement)

• VA Affiliation Agreement

Private Office Agreement Template without reimbursement

Children's Hospital Agreement Template without reimbursement

Integrated Addendum

• Please contact Haidy Nagib in GME if you had a recent program director change to update your current agreement(s).

Rotator Agreements

• Rotator Agreement Standard (other institution provides malpractice)
• STAPA Rotator Standard (other institution provides malpractice)

Credentialing Policies for UMMC Residents/Fellows, Visiting Residents/Fellows

• Credentialing Policy: Visiting Residents (Rotators)
• Credentialing Procedure: UMMC Residents and Fellows
• Credentialing Instructions and Guide to Forms for Residents/Fellows Going to/Covering the VA
• Confidentiality of Information Statement (Required for all visiting residents/fellows- including observers)
• Rotator Procedure: Medical Students