Application for Medical Student Rotation

Thank you for your interest in a clinical experience at the Family Medicine Residency of PhoenixBaptistHospital. We enjoy having students with us in the office (FamilyMedicineCenter), and in the hospital. We hope you have read the descriptions of our rotations on the web site or our brochures. Please let us know if you have any questions about filling out this application.

Requirements
We offer our clerkships to students who meet the following criteria: /
  1. You are currently a medical student in good standing in an AOA or LCME accredited medical school (U.S. and Canada only) Sorry, we do not provide clerkships to students from international medical schools
  2. The rotation is approved by your medical school and credited as a required or elective experience
  3. You or your school can supply us with the documentation listed below.
  4. The FMC clerkship targets third year students, while the subinternship is usually for fourth years. Exceptions can be made if positions are available. Third years requesting a subinternship position must have at least one month of inpatient medicine experience.

Instructions /
  1. Please call us to confirm the rotation and dates you are interested in. We may be able to give you tentative approval over the phone!
  2. Submit the attached application (mail, fax, or e-mail) to:
Phoenix Baptist Hospital Family Medicine Residency
Attn: Clerkship Coordinator
2000 W. Bethany Home Road, Phoenix, AZ85015
Fax: (888) 362-9698
Email:
  1. Ask your school (Dean’s office) to send us confirmation of the following:
  2. You are currently a student in good standing
  3. Your rotation with us will be approved for credit
  4. You are covered by your school’s liability (malpractice) insurance
  5. You have all the vaccinations and immunities expected of a health care worker
  6. You have been trained in universal precautions
  7. You have been trained in HIPPA (privacy) requirements
  8. A background check
  9. Positions are filled on a first come, first served basis. We will let you know when your rotation is approved!
  10. Rotations are offered in four week blocks. Please contact us for specific rotation dates.

Contact Information / Family Medicine Residency at PhoenixBaptistHospital
2000 W. Bethany Home Road, Phoenix, AZ85015
Phone: (602) 246-5521Fax: (602) 433-6641
E-mail:
Clerkship / Family Medicine Clinic, 8:00 – 5:30, M – F. Good for 3rd & 4th year.
Subinternship / Inpatient adult medicine, including ICU/CCU and telemetry. 6:30am – 5:30pm. OB and nursery experience also available. Includes night float for two weeks if more than one subintern is rotating. It is optional if you are the only one. Great for 4th years. Third years require prior inpatient medicine training and approval from the clerkship coordinator.
When would you like to do the rotation?
/ 1st Choice:
2nd Choice:
Comments/Requests
Your Name
Medical School(s)
& expected Grad Date
Year of school (at time of rotation?) / 3rd-year student 4th-year student
E-mail
Mailing Address
City, State, Zip
Whom should we contact in an emergency? Phone Number?
Can you tell us a little bit about your career plans? Why do you want to do a rotation with the Family Medicine program at Phoenix Baptist?

FORMALITIES(ask your school that the following be sent to us)*

  • A letter confirming that you are a student in good standing and that the rotation is approved for required or elective credit;
  • Documentation of medical liability insurance;
  • Documentation of all immunizations and titers expected of a health care worker.
  • You have been trained in universal precautions
  • You have been trained in HIPPA (privacy) requirements

* Documentation for University of Arizona students is all prearranged. You do not need to request additional paperwork.