Non- BCM Rotation Form - Residents/Fellows

Non- BCM Rotation Form - Residents/Fellows

Please download the elective rotation checklist & supporting documents packet here (the supporting documents has instructions on Castle Branch & TMB permit should you need it).

Do NOT sign within the hyperlink.

If coming from outside the state of Texas, please email patricia.perez@bcm.edu to receive the TMB spreadsheet.

**Note that it is you and your PCs responsibility to make sure the BCM PC and PD are aware of this rotation ahead of time and have approved this rotation**

You must submit your elective rotation forms at least 30 business days prior to rotation start date.

GME DOES NOT ALLOW ANYTHING BUT US CITIZENS, PERMANENT RESIDENTS, OR J-1 VISA HOLDERS THAT ARE ALREADY IN THE US.

** IF a J1 visa holder, you will need to have your TPL Advisor fill out your ISO form: J1 Visa Status

**IF a permanent resident, you can fill this form out: Permanent Resident Status

*this is for any J1 visa holders or permanent residents

First and Last Name*

Trainee's Email Address*

Date of Birth *

Trainee's date of birth

What program are you rotating to?*

Be specific. Example: Pediatric GI

What GME program are you current enrolled in at your currenty insitution?*

Be specific. Example: Pediatric GI

Current Institution*

Select or enter value

If another institution, what is your institution?*

Rotation Start Date:*

Rotation End Date:*

Have you ever rotated through BCM before?*

Yes

If you remember, what is your BCM ID number

Are You a US Citizen*

Please remember - we only accept J1 visa holder or permanenet residents who are currenly in the USA for their residency or fellowship training.

Yes

Non-US Citizens ONLY: What is your status?*

We only allow J-1 visa holders or permanent residents to rotate through. This will be checked out through BCM's ISO office.

** IF a J1 visa holder, you will need to have your TPL Advisor fill out your ISO form: J1 Visa Status We will not accept this ISO form from someone else or filled out by the trainee, it must be the TPL Advisor.

**IF a permanent resident, you can fill this form out: Permanent Resident Status

J-1 Visa

Permanent Resident

Are You Currently in the Military*

If yes, please upload a formal letter, from your supervisor, stating you have previously done a background check/drug screening and have proof of liability coverage.

Yes

Home Address*

Include City, State, & Zip Code

Cell Number*

Marital Status*

Married

Single

Emergency Contact Info & Relationship to Trainee *

Please tell us the name, phone number, & relationship to trainee

Is Your Director Aware of This Rotation?*

Yes

Program Coordinator Assigned to This Task?*

Please let us know your home program PC's information! If you can, please also add the BCM PC that will work with you during your rotation. *Ask your home program PC if you're unsure who to add as the contact.

Helpful tip: not Patricia Perez, she is the rotation GME point of contact.

Elective Rotation Files for Upload*

You will see, below, that there is a section to upload all required documents (up to 10 separate files).

**Please submit all documents at once. You cannot resubmit or edit. IF you are just missing the PLA or the TMB Permit (if outside the state of Texas) it is okay to submit everything else - we will add the PLA and/or TMB Permit on the back end once received.

BCM Liability Form & BCM Privacy Document (this form is in the elective packet embedded in the description of this elective application
Proof (an approval email) from BCM PC/PD that this rotation has been approved **
Proof of Professional Liability Coverage *if military personnel, a formal letter, from your superior, stating you have this is sufficient*
Castle Branch Background Check/Drug Screening (instructions are in the elective packet embedded in the description of this elective application) *if from an affiliated hospital or military personnel, a letter from the program stating this has been completed before is sufficient*
Copy of current TMB license or permit
Copy of most up to date ACLS, ATLS, or PALS from either the American Heart Association or American Red Cross
Proof of HIPAA Training, from your institution
Complete Immunization Records with most up to date Flu Shot, this is a must
Fully Executed Program Letter of Agreement - needs to be uploaded each time - ask your program for this

**NOTE: The BCM Badging Office makes any trainee coming in (that doesn't already have a BCM badge) to pay a fee of $20, paid in cash. This is not something they let us waive, so let your programs know. BCM Badging Information

Drag and drop files here or

Processing Fee:

(waived for US Military trainees & Affiliated hospitals in the Med Center):

$500 if GME is notified at least 90 days prior to start date
$750 if GME is notified less than 90 days prior to start date
$1250 for any elective scheduled between June 1 – July 31

*Fee is non-refundable.

Checks can be made out to:

Office of Graduate Medical Education

One Baylor Plaza 405A

Houston, TX 77030

I Confirm That I have Upload All Required FIles*

Send me a copy of my responses

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