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P ROGRAM:   ________________________________     PGY LEVEL*: _________

Please note both “Program functional PGY level” AND “Stipend PGY level” if these are different

BI-WEEKLY SALARY: _____________________       ANNUAL SALARY:________________

MEDICAL SCHOOL: _______________________     GRADUATED: _____________

EFFECTIVE DATES:   FROM __________(or date of licensure if later),  TO  _________

This agreement automatically expires 60 days from proposed effective date if

Massachusetts medical practice license and /or required visa is not approved by that time.  Expired agreement may be renewed at the discretion of the residency program director.                                   

The University:

  1. Appoints the above-named physician to a residency/fellowship position
  2. Agrees to provide an educational program that meets the General and Special Requirements of the “Essentials of Accredited Residencies” as established by the Accreditation Council for Graduate Medical Education (ACGME).
  3. Agrees to provide a stipend; vacation, sick and other leave; professional liability insurance; health insurance; other benefits; and advancement and due process procedures, all as specified in the UMMS Residency Programs Personnel Policies and in the UMMS Personnel Action Form.

The Resident/Fellow:

  1. Has received a copy of the UMass Chan Residency Programs Personnel Policies and Technical Standards.   Can meet these technical standards with or without reasonable accommodations(s) or academic adjustment(s), and agrees to abide by the policies and proces therein, and to the bylaws and policies of the University, of the Umass Memorial Medical Center  and of the hospitals and clinics to which the Resident/Fellow is assigned. 
  2. Agrees to fulfill the educational and clinical responsibilities of the graduate medical training program, during the effective dates, as stated in the ACGME Special Requirements and other approved standards; and in accordance with the policies, procedures, and goals/objectives of the Residency/Fellowship Program.
  3. Agrees to the release of information, by the professional liability program, pertaining to the Resident’s professional practice; agrees to report to the University or its agent(s) incidents involving potential liability during the performance of professional services as part of the residency program which occur either at the U.Mass Memorial Medical Center  or any other health care setting; and agrees to provide reasonable cooperation in the investigation and defense of any such incident by the University.
  4. Agrees to release of performance information by the program as required for ACGME accreditation, Specialty Board Certification, State Licensure and other relevant regulatory agencies.  Agrees to release of information as required for reimbursement by third party payers
  5. Shall obtain and maintain a valid Massachusetts Full or Limited Medical Practice License; and, as appropriate, a proper visa.  Failure to maintain such license and visa shall be grounds for termination.
  6. Shall authorize and successfully complete the  Medical Center resident physician credentialing process.