Forms & Templates

• Program Agreement Template* (.doc) UPDATED 10-2009
  *FOR UHS, THE FIRST PAGE OF THE PLA MUST BE ON UTHSCSA LETTERHEAD AND TWO ORIGINALS ARE NEEDED
• Christus Santa Rosa Program Agreement Template (.doc)
• Business Associate Agreement (BAA) Template (.doc)
• Form for Non-Hospital Rotations - .pdf or .doc
• Program Director Oversight of Site Director form (.doc)
• Process for Accepting Transferring Residents (.doc)
• Probation Letter (MS Word)
• Template for Administrative Status Letter (.doc)
• Template for appendix to contract for residents/fellows paid by UTHSCSA
• Evaluation Form for Professional Presentations - .pdf or .doc
• Resident Final Evaluation and Verification of Credentials Policy  -  Resident Final Letter Template
• Annual Progress Reports for Graduate Medical Education Programs at UT Health Science Center at San Antonio Ms Word or .pdf
• Alumni Survey Template (generic) - .doc
  This template can be used to produce a one-page, double-sided survey for administration to your program graduates. Insert the name of your program in place of the bold, italicized red print. Then, mail the survey with a suitable cover letter to your alumni. This survey assesses the short and long term outcomes of your program and the information obtained can be used to improve your program and curriculum. (This survey helps to close the assessment-outcome loop in competency-based education.)
• Alumni Survey Template (internal medicine and subspecialties) - .doc
  The program requirements for residency education in the subspecialties of Internal Medicine mandate a system of evaluation of graduates. The suggested format is a written survey after 1 year and every 5 years thereafter. The data from alumni surveys should be used to determine the degree to which the program's stated educational goals are being met. This template can be used to produce a one-page, double-sided survey for administration to your program graduates. Insert the name of your program in place of the bold, italicized red print. Then, mail the survey with a suitable cover letter to your alumni. Although the Internal Medicine core program requirements do not mandate an alumni survey, evaluation of graduates provides an excellent way to assess the short- and long-term outcomes of residency training.
  
• Outcome Assessment by Employer (.doc )