New Clinician Orientation Enrollment Form FY25

New Clinician Orientation Enrollment Form FY25

Please use this form when enrolling new clinicians in New Clinician Orientation.

Please note, orientation dates are available first come, first serve. Please submit your forms as soon as you know you have someone starting.

PLEASE NOTE: New Clinicians CANNOT attend NCO or eStar training until their start date due to the Fair Labor Standards Act.

Provider First Name*

LEGAL FIRST NAME - DO NOT PUT PREFERRED NAME

Provider Last Name*

Enter name shown on government identification (legal name)

Provider's VUMC ID*

If their VUMC ID has not been created yet, please put the expected date the VUMC ID will be activated.

Provider's Email Address*

Please provide a personal and VUMC email address for communications regarding NCO (if they do not have a VUMC email please enter their personal email) *DO NOT enter an email address associated with their current employer*

Please use a semicolon ";" to separate each email address.

Please select the new provider's job role*

***If your new provider is a Clinical Fellow/Instructor going through GME onboarding, PLEASE ensure you choose the correct option, i.e. GME Clinical/Fellow/Instructor and not MD, DO, OD.

Select

Are they brand new to VUMC?*

Select or enter value

Please select their previous role at VUMC*

Select or enter value

Please enter their last day in previous role*

Is the Provider Medical or Professional Staff?*

Medical Staff (MD, DO, OD, PsyD,etc.)

Professional staff (CNM, NP, PA, etc)

Medical Staff are typically faculty at either the SoM or SoN

Select or enter value

Is the Provider faculty?*

Select or enter value

Faculty Appointment*

Select or enter value

Faculty Title*

NCO Session 2025*

Select or enter value

Provider's PCC, Department, or Service Line*

Will the Provider be moonlighting?*

Select or enter value

Moonlighting PCC/Department, or Service Line*

Workday Cost Center*

What is their job code (4-digit)?*

What is their hire date?*

When is their start date?*

Has their credentialing gone through?*

Select or enter value

Expected Credentialing Date*

When will they start seeing patients?*

Where will the Provider see patients?*

Select or enter value

Inpatient Consults*

Select or enter value

Surgical Procedures*

Select or enter value

Are they any of the following who will bill/code?*

Select or enter value

Do they work in Radiology or Cardiology?*

Select or enter value

What type of Cardiologist/Radiologist*

Select or enter value

Will this Radiologist work remotely?

Select or enter value

Does the Provider have previous Epic Experience*

Providers may be eligible for abbreviated eStar Training.

Select or enter value

eStar provider training course(s)needed*

Please choose all applicable courses for your clinician.

Select or enter value

Is the provider any of the following?*

Please be sure to review this section to ensure your new clinicians are enrolled in all of their required classes.

This question will trigger specialty class requests like Transplant, Cardiology, Orthopaedics, etc.

Select

Specialist Provider Training - Instructor Led

Select or enter value

eStar Training Date*

Please select all applicable courses for the new clinician's role.

Schedule can be found by clicking the web address: www.vumc.org/nco/estar-training-new-clinicians

*Class enrollment cannot take place until active VUMC ID is received by our department. Please send the VUMC ID to newclinicianorientation@vumc.org as soon as their VUMC ID is active.*

Dept Contact*

First Name Last Name

Department Contact Email Address*

Security Manager*

First Name Last Name

Which NCO Track should they be enrolled in?*

Select or enter value

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