GME Data Sheet
| Form Name: | GME Data Sheet |
|---|---|
| Completed By: | House Officer |
| Used When: | Completed by all incoming House Officers; updated by internal Transferring House Officers and updated by Graduating/Terminating House Officers |
| Purpose: | Contains information needed by LSU GME Office and Hospital GME Offices for federal reimbursement. |
| Direct Questions To: | Yolanda Lundsgaard |
| Form Link: | Autopopulated for newhires: Newhire Documents |
Instructions for Completing Form
This form is completed automatically as part of the online Newhire Documents process. It is included in the Newhire Packet that is submitted to the GME Office. It is also completed and submitted to the GME office when a House Officer is transferring between programs.
Only the first page of the Data sheet is required for House Officers that Match or are accepted to LSU training programs immediately after graduating from Medical, Osteopathic, and Dental School.
House Officers that graduated Medical, Osteopathic or Dental School more than 2 months prior to their start/appointment date, must complete both pages of the Data sheet to include a continuous and inclusive list of internships, residencies, fellowships, staff positions, leave of absences, etc. from Medical, Osteopathic and Dental School Graduation through LSU training program start/appointment date. There should NOT be any gaps in dates.
Other Info
A blank 2nd page for the GME Data Sheet may be downloaded here.
Places This Form is Referenced
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GME Program Exit Packet (Forms & Documents) —
Instructions for Completing Form
This packet is to be completed for each House Officer not continuing with the program (ex. graduating, transferring, and terminating) and sent to the GME office (GME Electronic Submission Site )within 30 days of departure with the checklist. (Scans can be sent to gme@lsuhsc.edu) NOTE: If a resident is OFF CYCLE, please send the packet to the GME office within 30 days of departure.
Other Info
The following items should be included in the packet (or check off the checklist to indicate they were completed):
Copy of diploma, resignation letter, or supporting documents
Updated GME Data Sheet (Must include all training/jobs/LOA from Medical School thru Residency/fellow training including training completed or leaving if not completed.)
Procedure log/Case log summary (if applicable, Summary listing)
Copy of Personal Data Change Form (original should be sent directly to Human Resources). If no address change, put NA on the form and include in packet. https://www.lsuhsc.edu/ps/support/docs/Employee%20Self%20Service/2025%20Docs/1NO/Create_a_Personal_Data_Change.pdf
For Program records/Action Items:
Duty Hour Compliance Report showing up to date completion saved in program files.
Core Curriculum / AMA GCEP completion summary report saved in program files.
Copy of updated CV saved in program house officer files
Copy of completed LCMC Health_EXIT-House Staff Clearance Form_5.2025.pdf
Verify the resident’s file is complete and organized according to the House Officer Portfolio Checklist
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GME Data Sheet (Forms & Documents)
LSU GME Knowledge Base
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