Chattanooga Coordinator Forms
- Academic Performance Improvement Plan (PIP) Forms
- ACGME-Mandated One-Time GME Leave Form
- Acknowledgement Form for GME Interviews听
听 - Annual Resident/Fellow Agreement听
听 - Event Request Form Not Related to Well-Being (Chattanooga)
- GME Policy #750 - Resident Travel and Professional Development Reimbursement
听 - GMEC Approvals for Program Requests
- IHI Charter - Quality Project Template
听 - QIPS Day Proposal Submission Form
听 - Quality Improvement & Patient Safety Project List - Chattanooga (To be updated by Coordinators)
- Request for Off-Site Elective Rotations (Other UT Campuses, In-State Non-UT Sites,
Other States, and International Off-Site Elective Rotation [GME Policy #530 in Word
format]听
- Resident Evaluations and Verification Templates [Word Format]
- Form #1:听 Resident Request to Transmit Final Summative or Verification Information
- Form #2:听 Resident Final Summative Evaluation
- Form #3:听 State Medical Board [Typical no Derogatory Information]
- Form #4:听 State Medical Board [Derogatory Information and Dismissal]
- Form #5:听 Response to Employer, Credentialing Committee, & other Inquiries听[Typically
requested from Chair or Program Director]
- Form #6:听 Personal Reference/
Recommendation from Faculty [suggested wording from the UT General Counsel]听听
听
- Form #1:听 Resident Request to Transmit Final Summative or Verification Information
- Survey Tools Recommended by UTHSC IT听
- (login with your UT Net ID and password as your school account)
- 听
- Visiting Resident Approval [GME Policy #180]
听 - Visiting Resident Application Form [GME Policy #181]
- Well-Being Activity Proposal (Chattanooga) Template Form
- Well-Being Institutional Policy - Chattanooga 听[GME Policy #222]
- Well-Being Institutional Policy - Chattanooga: Funding, Resources, and Outcomes [GME
Policy #223]
- Zoom - Creating an Account and Login