Ultrasound (US) or ECG Model Request Form

Thank you for your interest in US or ECG models from the Stanford School of Medicine's Center for Immersive and Simulation-based Learning / Standardized Patient Program (CISL/SPP).


Please fill out the information below to request an ultrasound model(s) or ECG model(s) for your Stanford event. We are unable to provide models for any events outside of Stanford. Please note that Stanford US models do NOT do any internal ultrasound or any scans that require the removal of underpants or bra.


IMPORTANT NOTE: CISL must receive this request at least FOUR WEEKS (not including holidays) prior to the event by 5pm PT in order to accommodate the request (for example, if your event is on a Thursday, it must be received by 5pm on Thursday, four weeks prior). More time is always preferred. If four weeks prior to the event falls on a holiday, the request must be received on a WEEKDAY prior to the holiday. Please note that Stanford observes a 2-week Winter Closure, so if requesting a model for an early-mid January event, you must add 2 weeks to the timeline (essentially 6 weeks).


Additionally, we can't guarantee that we'll be able to book the number and type of US/ECG models requested.There is a 2-week cancellation/change policy (cancellation OR changes must be requested at least 2 weeks before the event through Medscheduler), and the requester is responsible for covering sick leave if an US model calls out sick; see Agreement of Terms at the end of the form for additional details.


Asterisk indicates required fields. Thank you.


MASKING INFORMATION: We will follow whatever the current guidelines are (as set forth by Stanford Healthcare and Santa Clara County).. Whatever masking protocols are in place at time of booking must be adhered to even if restrictions loosen. We will let you know if masking is required for your event if we can accommodate your request.

We must have an account number before we can start making inquiries for booking. We are only able to process ONE PTA or cost center number. If you have neither of these accounts, write "invoice" and you will need to pay by check prior to the event.

Please note that some demographics may be harder to find. We cannot guarantee that we will be able to get the type and number of models that you have requested, but we will do our best. The more time we have to make inquiries, the better. We cannot send out inquiries without this information.

Start and end time

[Please see Agreement of Terms (below) for specifics about US/ECG model hours and breaks.] Time to change into a patient gown and get set up is time on the clock: 15 mins. The same is true for breaking down and changing into street clothes: another 15 mins. In other words, if you need the models to be ready to go at 1:30pm, they will need to arrive at 1:15pm. If they are in the session until 5:30pm, their end time will be 5:45pm. This also applies before and after an off-the-clock meal break.

We must know the timing of the event (including at least one 15-minute break if scanning longer than 2.5 hours) before we can start making inquiries for booking. If your event runs all day and you'd like to split the day into 2 shifts with 2 sets of models, please indicate that in the schedule.

We must know in advance which parts of the body will be scanned so that the models can decide whether they want to be involved or not. Please list parts of the body (instead of the name of the scan) so that a layperson would understand what the scan will entail. NOTE: If the type of scanning is not listed and communicated before booking the model, it may not be performed on the model during the event. We cannot send out inquiries without this information.

Please include the level of learner, how many learners a model would see during the shift, and if they will be in small groups or other configurations, etc.

Filming / Photography

If you plan to film or photograph the US models (or if you expect that your participants will), you MUST provide your filming/photo release form prior to the SP Program sending out inquiries so that the US model(s) can review it and decide whether or not to participate. This must be provided at least 4 weeks prior to the event or we will not be able to accommodate.

Select or enter value
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If filmed/photographed for outside use (including social media), we cannot use any of our models who are members of the Screen Actors Guild (they can do filming for in-house use only). Enter N/A if there will be no video/photos.

If you are taking photos or filming, we must have a copy of this form prior to making inquiries. Please note that your team will be responsible for collecting signed forms.

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Agreement of Terms

* Pay rate is $50/hr for US/ECG models. There is also an SU fringe benefit cost of 11.8% added to all US/ECG model wages.


* Parking must be provided. A parking permit costs $21/permit per model for weekday events in the Immersive Learning Center.


* There is a 4-hour minimum payment, even if the model is used for less time.


* You may only scan the parts of the body that were agreed upon prior to booking the model(s).


* All US models wear underwear (and bra if the model has breast tissue). You may not ask the model(s) to remove their underwear.


* 15 minutes to prep and change prior to the event and 15 minutes to clean up and change at the end of the event is paid time on the clock. If there is an off-the-clock meal break, the models need 15 min to clean up prior to lunch and 15 mins to change into patient gowns after lunch.


* If you want the model to do any prep prior to the session (e.g. fasting), that is paid time on the clock.


* For a 3-4 hour shift, there must be a 15-minute break in the middle of the shift per CA and Stanford labor laws. If the shift is longer than 6 hours, there must be a 30-minute meal break (unpaid) after 5 hours. A model cannot work longer than 6 hours without a meal break. An unpaid meal break may last no longer than one hour.


* If a shift is over 8 hours, there must be written approval of overtime. Pay for overtime is time and a half: $75/hr.


* US/ECG models must be examined on an exam table or massage table. You may not use a regular table.


* A filming/photo release form must be provided at time of request if applicable. If you are not planning to film or photograph your event, you MUST instruct your participants that taking photos/videos of the US models is NOT allowed.


* There is a 2-WEEK CANCELLATION / CHANGE POLICY. If a model has been booked for an event, and they are canceled with less than 2-weeks’ notice, the model will be paid for the time contracted. The same is true if you reduce the hours of a model with less than 2-weeks’ notice - for example, if you reduce the shift time from 6 hours to 4 hours less than 2 weeks before the event, the model will still be paid for the originally booked 6 hours. The cancellation or change MUST be made through the Medscheduler website by going to ILC Reservations and submitting a change or cancellation form to remove or change the US model resource. An email does not count as official notice. If you are at the 2-week mark, the form must be received by noon (12 pm) to not be responsible for payment. Note, details of the event (including number of models, types of exams, etc.) CANNOT be changed less than 2 weeks before the event.


* The SP Program cannot guarantee that an US model won't get sick. If you'd like to book a backup, the cost for a backup model would be the same. If an US model calls out sick, the requester will be responsible for the cost of the sick leave (same amount as wages), charged to the PTA provided. If there's no backup model, the SP Program will endeavor to find a replacement for the sick model if requested, but cannot guarantee one will be found.


* SP Program and US model availability is dependent on other scheduled events and is not guaranteed.

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