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Graduate Medical Education

Affiliation Agreements

Flowchart for New and Renewing Affiliations

Guide for Selecting the Correct Affiliation Template

Request for Affiliation

• EXAMPLE of Completed Form

Standard Affiliation Agreements and Annotation Instructions for ACGME Field Surveyors

• Standard Affiliation Agreement Template with reimbursement
• Standard Affiliation Agreement Template without reimbursement

Non-Standard Affiliation Agreements and Annotation Instructions for ACGME Field Surveyors

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

Johns Hopkins University/Hospital and Annotation Instructions for ACGME Field Surveyors

• Johns Hopkins University/Johns Hopkins Hospital

  (Use for UMMC's residents/fellows rotating AT Hopkins)

MedStar Affiliation Agreements and Annotation Instructions for ACGME Field Surveyors

• MedStar Affiliation Agreement Template with reimbursement
• MedStar Affiliation Agreement Template without reimbursement
• Rotating Resident/ Fellow Registration Process

Mercy Affiliation Agreements and Annotation Instructions for ACGME Field Surveyors

• 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 Agreement and Annotation Instructions for ACGME Field Surveyorss

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

VA Affiliation Agreements and Annotation Instructions for ACGME Field Surveyors

• VA Affiliation Agreement

Private Office Agreement Template without reimbursement and Annotation Instructions for ACGME Field Surveyors

Children's Hospital Agreement Template without reimbursement

Rotator Agreements

• Rotator Agreement Standard (other institution provides malpractice)
• Rotator Agreement Non-Standard (UMMC  provides malpractice)
• Rotator Agreement MedStar
• Rotator Rider JHH/JHU    (Use for Hopkins's residents/fellows rotating AT UMMC)
• STAPA Rotator Standard (other institution provides malpractice)
• STAPA Rotator Non-Standard (UMMC  provides malpractice)

    

This page was last updated on: January 31, 2013.

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