AU ROTATION CHECKLIST

Completed Rotation Checklist and all items listed must be submitted to the MCG GME Office at least 60 days prior to the scheduled Computer Training class.

RESIDENT NAME AND DEGREE COPY OF MEDICAL DIPLOMA
CURRENT DEPARTMENT/PROGRAM	 	 CONTACT/PROGRAM COORDINATOR	 		 AU ROTATION DATES & DEPARTMENT(S)	 	

              

CRIMINAL BACKGROUND FORM PERSONAL DATA FORM
VETERANS SELF-IDENTIFICATION FORM	 	

Submit completed Rotation checklist and complete packet to:
Medical College of Georgia- AU Graduate Medical Education Office Attn: Erica Bass, BA Coordinator, AU Residency Programs 1459 Laney Walker
Blvd. AE 3039
Augusta, Georgia 30912

SELF-IDENTIFICATION OF DISABILITY FORM        	  CONFIDENTIALITY STATEMENT	 		  SEXUAL HARASSMENT POLICY FORM	 		  ETHICS POLICY FORM
INFORMATION SYSTEMS/COMPUTER USAGE        	 MCG DATA FORM
CV/RESUME

CURRENT SHOT RECORDS AND PPD
 OCCUPATIONAL HEALTH PACKET
	
HIPAA TRAINING TEST FORM NPI NUMBER
MEDICAL LICENSE OR RTP APPLICATION	 	

DATE OF BIRTH

RESIDENT PHONE NUMBER

RESIDENT E- MAIL ADDRESS			   _________________________________

AU GME Office use only
 E-PAR submitted__________________________________  Paperwork to HR____________________________________________________
NET ID Issued_____________________________________Institutional DEA____________________________________________________
PPG number_______________________________________Service Now Access requested__________________________________________
Badge form sent for signature_________________________ Badge form to badging________________________________________________
NET ID#, Outlook ID, NPI#,DEA# and PPG# emailed to resident and program coordinator____________________________________________
Blue book picked up by resident or program coordinator________________________________________________________________________
Computer Training class scheduled_____________________ASEPSIS Course scheduled____________________________________________