Moonlighting Form

Form Name:Moonlighting Form
Completed By:House Officer
Used When:Completed by all incoming and transferring House Officers

Acceptance of the LSU Moonlighting Policy

Direct Questions To:Sara Blakemore
Form Link:

Automatically included in the Appointment Packet.

Moonlighting Form.pdf

Instructions for Completing Form

This form is included as part of the Appointment Packet for incoming and transferring house officers and must be submitted to the GME Office. It must be signed by the House Officer and the head of the department before submission.

Other Info

Related Content

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    Moonlighting (Terms and Abbreviations) Voluntary, compensated, medically-related work performed outside the institution where the resident is in training or at any of its related participating sites.
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    X.G. Moonlighting Policy (House Officer Manual)
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    V.A. Professional Liability (Malpractice) Insurance (House Officer Manual) — The State of Louisiana provides professional liability coverage pursuant to LSA-R.S. LSA-R.S. 40:1237.1 et seq. to House Officers when acting within the course and scope of their training under the supervision of a health care facility to which they are assigned as part of their prescribed training, regardless of where the services are performed. However, House Officers assigned to a health care facility outside the state of Louisiana may be required to provide additional professional liability coverage with indemnity limits set by the House Officer's Program Director.

    House Officers are not provided professional liability coverage under LSA-R.S. 40:1237.1 et seq. when engaging in ANY professional activities outside the scope of the House Officer Program. All professional liability matters should be directed to the Vice Chancellor of Community and Multicultural Affairs (504-568-4810).

  • Page:
    Outside Activities (Agreement of Appointment)
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    Moonlighting Form (Forms & Documents)

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