Resident Requirements – GME Clearance Card Checklist

The Graduate Medical Education (GME) Clearance Card Checklist lists all the required documents and forms for residents, which are also listed below. Follow the links to complete the necessary forms and view the Inova training documents. *Please note: The GME forms can now be completed electronically! Simply download and save each form, select the 'Add Text' option under 'Sign' to complete the form. Once you have completed the form, select the 'Place Signature' option under 'Sign' to sign the form* Please email all required forms to GME Credentialing or fax form to 703-776-3201 if you are unable to complete the forms electronically. If you have any questions, contact the GME office at 703-776-2626. To Be Provided by Resident And/Or Institution Copy of Complete Academic Year Rotation Schedule (must include institution name, resident/fellow legal first and last name, PGY levels, name of rotation being completed and location of rotation) Copy of application to the program (ERAS or other military residents-PCS orders) Copy of CV complete with listing of participation in current residency/fellowship program Copy of Fully Signed Resident Agreement/Resident Contract (For the current academic year) Copy of Virginia Medical Training License Copy of ECFMG Certificate (if applicable) Copy of NPI Number Verification Copy of current ACGME Procedure Logs (For Orthopedic Residents ONLY) To Be Completed by Resident GME Clearance Card Form Identity Proof Verification Form (Clear copy of non-expired, government issued ID must be submitted with form) Confidentiality and Non-Disclosure Agreement for Clinical Trainees Influenza Vaccine Verification 2022-23(Rotators on site between October 1 - March 31, 2023) Proof of COVID-19 Vaccination or Exemption Request Mandatory COVID Vaccination Information Vaccination Exemption Request Forms   ORP Provider Application/Registration Verification PMP Registration Confirmation via the PMP Data Center (Instructions on Completing PMP Registration) Inova Alerts Sign-Up Instructions Inova Alerts Attestation EPCS Identity Proof Verification Form (if not previously submitted) (verification completed in GME office) Copy of Non-Expired Government Issued Photo ID (Verification completed in GME office) In order to be able to prescribe certain medications to patients, Virginia now requires our office to verify your identity prior to you starting your rotation here at IFMC. To ensure compliance with Virginia requirements, you must submit the following items to the GME office in addition to the above required credentialing documents:  Clear copy of your Non-Expired Government Issued Photo ID Clear copy of your Inova issued badge (if you are returning for a rotation) Completed EPCS form (can be found in GME Website link above; leave Provider ID blank if unknown) Required training modules are assigned by GME Department after resident paperwork is received and processed. GME will confirm completion of assigned online training modules. Epic Training Modules via HealthStream Annual Education for Acute Care Clinical Staff via HealthStream  Equal Access: Language and Disability Services via HealthStream iMed Consent for Providers via HealthStream