PLA Signature Request Form

For programs to obtain DIO signature.


If you requesting signatures for a visiting resident PLA, please send the form directly to Bettina Flores at BettinaFlores@stanfordhealthcare.org.


Any new rotations will need to be submitted to the New Rotation Intake form at - https://app.smartsheet.com/b/form/b784df79e5eb4834acb0b444fde84cb1


PLA templates - https://med.stanford.edu/gme/program_portal/programs/forms.html#program-letter-of-agreement-(pla)


Note - all standard PLAs will need to include Goals & Objectives

Find your GME PM at https://med.stanford.edu/gme/program_portal/programs/gme_program_manager.html

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I confirm I am either the Program Director or Program Coordinator of the Stanford program listed above.


AND


The attached PLA also has Goals and Objectives attached.

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