Form Name:	Appointment Form
Completed By:	Program Coordinator
Used When:	Submitted each spring for the upcoming academic year.
Purpose:	This form is used by the GME office to assist with accurate contracts and other documentation.
Direct Questions To:	Yolanda Lundsgaard
Form Link:	Academic Year Appointments

Instructions for Completing Form

The appointment form is completed automatically with the data from New Innovations. The completed form should be downloaded, printed, signed, and submitted to the GME Office.

Other Info

This form must be resubmitted to the GME office any time a change is made to any resident's appointment information.

The form contains the following information:

House Officer Name
House Officer Level for the Academic Year
House Officer Status:
- New appointment – House Officer is new to the Training Program. Including Transfers from other LSU programs
- Re-Appointment – House Officer is continuing in the same Training Program. House Officers promoting to the next House Officer level July 1 are usually continuing House Officers.
- Hold-Over – a continuing House Officer that is Off-Cycle; or repeating the year and remaining the same House Officer Level either for the entire Academic Year or part of the Academic year, (aka, Exceptions, or Off-cycle).
Appointment Date and End Date – the date the House Officer is appointed/starts for the Academic Year The appointment date is July 1; and the end date is June 30 of the Academic year, unless the House Officer is off-cycle.
- If the House Officer is Off-Cycle or a Hold-over that will promote to the next House Officer level during the Academic year, the House Officer will be listed twice on the form. The first entry appointment date will be July 1, because that is the first day of the Academic Year; the end date will be the day before his/her promotion date. The second entry appointment date will be the date he/she promotes to the next level in the academic year; the end date is June 30, the last day of the Academic Year.
- If the House Officer is Off-cycle or a hold-over that will terminate before June 30 of the Academic year, he she will be listed once. The appointment date will be July 1; the end date will be his/her last paid day in the program or Termination cob date.
Program Start Date – the date the House Officer entered the residency/fellowship training program
Expected Graduation Date – the date the House Officer is expected to complete residency/fellowship training in the program.
Salary – the approved annual salary for the Academic Year for that House Officer level/or training level for the program.
FMG – Indicates if the House Officer graduated from a Medical school out-side the U.S. This field is Not applicable for Dental residents unless they completed Medical School too.
In/Out – used by GME office for tracking files
3-Digit Number – used by GME office

Places This Form is Referenced

Page:

UMCNO Meal Card Tracking (Forms & Documents)
Page:

LCMC Visiting House Officer Packet (Forms & Documents)
Page:

UMCNO Learner Code of Conduct (Forms & Documents)
Page:

Visiting House Officer Checklist (Forms & Documents)
Page:

LSBME Permit Renewal Spreadsheet (Forms & Documents)
Page:

LSBME Letter of Commitment PGY 2 (Forms & Documents)
Page:

LSBME Letter of Commitment - PGY 1 (Forms & Documents)
Page:

Incoming House Officer Checklist (Forms & Documents)
Page:

Paperwork Submission Timeline (Forms & Documents)
Page:

EQuIP Participation Outline (Forms & Documents)
Page:

Summative Letter Template (Forms & Documents)
Page:

Request for Authorization to Serve Alcohol (Forms & Documents)
Page:

DIO Transfer Approval Packet (Forms & Documents)
Page:

Data Sheet for Visiting Residents and Fellows (Forms & Documents)
Page:

Mask Fit Test Medical Form (Forms & Documents)

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