Memorandum of Understanding Concerning
Affiliation of Residents For Clinical Training
This is a memorandum of understanding on the part of      , hereinafter referred to as "Facility" and the Board of Regents of the University System of Georgia on behalf of the Medical College of Georgia, hereinafter referred to as "MCG".
A.	Purpose:
The purpose of this Memorandum of Understanding is to guide and direct the parties respecting their affiliation and working relationship, inclusive of anticipated future arrangements and agreements in furtherance thereof, to provide high quality clinical learning experiences for residents in the Facility’s (ACGME Residency Program).
B.	General Understanding:
1.	The courses of instruction (i.e., clinical education programs) to be provided will be of such content and cover such periods of time as may from time to time be mutually agreed upon by the Facility and MCG.  The starting and ending date for each program shall be agreed upon at least one month before the program commences.
2.	The number of residents designated for participation in a clinical education program will be mutually determined by agreement of the parties, and may at any time be altered by mutual agreement.  All participants must be mutually acceptable to both parties and either party may withdraw any resident from a program based upon perceived lack of competency on the part of the resident, the resident's failure to comply with the rules and policies of MCG or the Facility, or for any other reason where either party reasonably believes that it is not in the best interest of the program for the resident to continue.
3.	There shall be no discrimination on the basis of race, national origin, religion, creed, sexual orientation, age or handicap in either the selection of residents for participation in the program, or as to any aspect of the clinical training; provided, however, that with respect to handicap, the handicap must not be such as would, even with reasonable accommodation, in and of itself preclude the resident's effective participation in the program.
4.	Residents participating in the clinical education program at Facility will be subject to the policies, rules and procedures of Facility.
C.	Facility Responsibilities:
1.	Facility will retain responsibility for the care of patients and will maintain administrative and professional supervision of residents insofar as their presence and program assignments affect the operation of Facility and its care, direct and indirect, of patients.
2.	Facility will provide adequate clinical facilities for participating residents in accordance with the clinical objectives developed through cooperative planning by the Facility and MCG.
3.	Facility staff shall, upon request, assist MCG in the evaluation of the learning and performance of participating residents.
4.	Facility shall provide for the orientation of participating residents as to the facilities, philosophies, rules, regulations and policies of the Facility.
5.	All medical or health care (emergency or otherwise) that a resident receives at the Facility will be at the expense of the individual involved.
D.	MCG Responsibilities:
1.	MCG will use its best efforts to see that residents selected for participation in the clinical training program are prepared for effective participation in the planned clinical activities.  MCG will retain ultimate responsibility for the training of its residents.  MCG will select only those residents who have satisfactorily completed the prerequisite didactic portion of their curriculum for participation in a program.
2.	MCG will require all participating residents to show proof of professional liability insurance of a nature and in amounts satisfactory to Facility.  MCG will also require all participating residents to show proof of health insurance in an amount satisfactory to Facility.  Upon request, evidence of such insurance will be provided to Facility.  MCG will notify Facility immediately should such insurance be terminated, canceled or altered.
E.	Mutual Responsibilities:
1.	The parties will work together to maintain an environment  of quality clinical learning experiences and quality patient care.  At the instance of either party a meeting  or conference will be promptly held between Facility and MCG representatives to resolve any problems or develop any improvements in the operation of the contemplated clinical training program.
2.	Unless sooner canceled as provided below, the term of this affiliation for clinical training shall be       (indicate # of years)  years, commencing on (indicate date), 20     , and ending on (indicate date), 20     .  This working relationship and affiliation may be renewed by mutual written consent of the parties.  It may also be canceled at any time by either party upon not less than ninety (90) days written notice in advance of the next training experience.
Facility:
(Name)      	
(Address)      	
(Authorized Official)      		Date:      	
Board of Regents of the University System of Georgia
on behalf of the 
Medical College of Georgia 
Augusta, Georgia 30912
		Date:      	
Daniel Rahn, M.D., President