Visiting Resident Rotation Request


If your institution already has an affiliation agreement with UT Dell Med or Ascension, requests must be submitted at least 30 days before the desired rotation start date. If no agreement is in place, requests must be submitted at least 6 months in advance.



  • Before completing this form please be sure to fill out the attached Authorization Form with the receiving Ascension / Dell Med Program Director's or Sponsoring Physician's Signature. You will be required to upload this document at the bottom of this form.
  • It is the responsibility of the Visiting Resident to make sure the Ascension / Dell Med Program Coordinator and Program Director are aware of this rotation ahead of time and have authorized this rotation.
  • A visiting rotator must be a U.S. Citizen, Permanent Resident, or J-1 Visa Holder already within the United States in order to be eligible to rotate.
  • Any outside rotators must contact the Texas Medical Board (TMB) for instructions on obtaining a Rotator Physician in Training Permit (PIT). Please contact TMB at pits@tmb.state.tx.us.
 

Must be at least six months from date of submission.

 
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Please select if you are military

 

Please select the specialty you will be rotating with

 
 
 

Please check if you have rotated with us before

 

Please select your institution if it is contained within the dropdown, if not select other and enter your Home Institution

 
 
 
 
 
Phone
 
 

Please attach the authorization form and the Program Letter of Agreement (PLA) with the receiving Ascension / Dell Med Program Director's or Sponsoring Physician's Signatures. Both documents are required.

Drop your files here
 

Next Steps

Upon submission of this form, Ascension will begin preliminary processing of your application materials and the process will continue as follows.


1. Preliminary Approval

  • This information is then sent to the DIO of GME at UT Dell Medical School for approval.

2. Attestation Form

  • Visiting Resident’s Program Coordinator will be sent an Attestation Form to complete.

3. Academic Affiliation Agreement / PLA & Supervision Grids

  • An Academic Affiliation Agreement will be submitted for creation, if one is needed. This will be completed by Academic Administration and the outside institution.
  • If an agreement is already in place, and an amendment is not needed, then we can proceed to the next step.
  • A $250 Processing Fee request will be sent to the Visiting Resident. (This fee is waived for Military, Houston Methodist, and UTMB Craniofacial Residents.)
  • Visiting Resident’s Coordinator will provide a signed PLA, Schedule B Form, and Supervision Grid.

4. New Innovations Checklist

  • A profile will be created in New Innovations for the Visiting Resident and an onboarding Checklist will be assigned.
  • The following Documents are needed in the checklist:
  • Rotator Information Form
  • Letter of Good Standing
  • Professional Liability Certificate
  • Terms of Use Agreement
  • Upload Badge Photo
  • Rotator Compliance Modules
  • Rotator Attestation
  • DUO Authentication FAQ

5. Provisioning & Badge Creation

  • A provisioning request will be submitted and once the logins are created the information will be emailed to the Visiting Resident on the first day of their rotation.
  • A request to have a badge created will be submitted and the visiting resident will be notified when and where they can pick up their badge.

6. Visiting Resident is Cleared to Start their Rotation