Integrity Commitment Advocacy Respect Excellence

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GME Health Professions Trainee Application Package for Academic Year 2015-2016

GME staff is available to assist new GME trainees and Medical School staff Mondays through Fridays,

8 a.m. – 11:30 a.m. and 1 p.m. – 4:30 p.m., throughout the Academic Year, with any issues needing to be resolved prior to the beginning of the scheduled VA rotations.

In this package, you will find the following:

1. A “welcome” letter from Dr. Dione M. Farria, Designated Education Officer, Southeast Louisiana Veterans Health Care System;

2. A “welcome” letter from Ms. Inger Alston, Chief, Human Resources Management Service– please sign and return this letter;

3. A “welcome” and information letter from Ms. Janice Williams, Administrative Officer, Workforce Development Service, Graduate Medical Education;

4. The Medico-Legal Responsibilities of House Staff letter – please sign and return this letter;

5. The VA Application for Health Professions Trainees, VA Form 10-2850d– please complete and return;

6. Standard Form 61, Appointment Affidavit – please sign in presence of notary and return this form;

7. VA Form 0711, Request for Personal Identification Verification Card; please complete and return these two pages – in Section I complete 1,2,3,4,7,8,9; in Section III complete 3-9;

8. A copy of Numbered Memorandum 00-4, “Protection of Patients From Abuse”; sign and return the acknowledgement page only;

9. The SLVHCS Health Professions Trainee Orientation Packet; sign and return the acknowledgement page only;

10. A fact sheet and website address to the VHA National Desktop Library; and

11. Please use the checklist below to ensure you return all of the required documents.

NOTE: These all are Microsoft Word documents.

Please call Ms. Crystal Cruz at 504-566-8416 to coordinate “courtesy” fingerprinting appointments at the VA facility nearest to where out-of-town residents/fellows are located.

“Thank you for ‘Caring for our Nation’s Heroes’”!

DEPARTMENT OF VETERANS AFFAIRS

Southeast Louisiana Veterans Health Care System

P.O. Box 61011

New Orleans LA 70161-1011

Academic Year 2015-2016 / In Reply Refer To: 629/002C

WELCOME TO THE SOUTHEAST LOUISIANA VETERANS HEALTH CARE SYSTEM

During the coming months the clinical staff at Southeast Louisiana Veterans Health Care System (SLVHCS) will be privileged by having the opportunity to work with you to provide quality, compassionate and safe healthcare to our Nation’s Veterans.

Before your training experience can begin with this agency, you will need to complete and return some of the enclosed forms. Although many of the documents may be duplicates of those required at other medical facilities at which you will be trained, they are also required for employment with the federal government. Please complete, sign and return ALL required items.

Before you are covered under the federal tort provisions in the event of MALPRACTICE CLAIMS AND PERSONAL LIABILITY, all required VA paperwork MUST be received and processed by the Southeast Louisiana Veterans Health Care System PRIOR to your first day in training and/or duty status.

Please return the required documents, complete mandatory online training, have your fingerprints taken, and have your PIV Card photo taken within the prescribed timeframe preceding the start of your VA rotation.

If you have any questions concerning this application, please contact Ms. Janice Williams, via

e-mail, at or telephone number (504) 566-8408.

Thank you for your cooperation and we will see you soon.

/s/

Dione M. Farria, M.D.

Designated Education Officer

Enclosures:

In Reply Refer To: 629/002C

Academic Year 2015-2016

APPOINTMENT LETTER FOR TRAINEES PAID

THROUGH A DISBURSEMENT AGREEMENT

Dear VA Health Professions Trainee:

Welcome to the Department of Veterans Affairs (VA) and the Southeast Louisiana Veterans Health Care System (SLVHCS). You will be given a without compensation appointment at our facility as a Medical Resident/Fellow between July 1, 2015, through June 30, 2016, under the authority of Title 38 United States Code (U.S.C.) 7406. During your period of appointment to our facility, you will be paid by VA using a disbursement agreement with LSU Health Sciences Center and will be authorized to perform services as directed by your SLVHCS Site Director.

Acceptance of this letter, as signified by your signature below, and completion of the Standard Form (SF) 61 prior to the start of your training, serves as your appointment authorization for this training period. If you have prior federal service, you are requested to report to our Human Resources Management Office within 14 days of the beginning of your rotation for additional appointment information and processing. Please bring this letter with you, as well as any documents you may have relating to your prior federal service.

Sincerely yours,

/s/

Inger Alston

Chief, Human Resources Management Service

Enclosure: SF 61

______

(Signature) (Date)

______

(Printed or Typed Name)

______

(Home Address)

______

(School and Program)

In Reply Refer To: 629/002C
Academic Year 2015-2016

Welcome to the Southeast Louisiana Veterans Health Care System!

I’m delighted to welcome you as a new health professions trainee during Academic

Year 2015-2016. I’m here to provide assistance to you as you begin your on-boarding journey.

I’m sure you will find, as have thousands of previous and returning health professions trainees, that the Southeast Louisiana Veterans Health Care System’s training empowers you to acquire the knowledge, skills, and the experience necessary to care for our Nation’s Veterans in today's broad medical practices, while preparing you to be one of the best health care providers in the 21st Century.

Due to regulations mandated by the Department of Homeland Security and the Health Insurance Portability and Accountability ACT (HIPPA), fellows and residents who will be rotating at the Southeast Louisiana Veterans Health Care System must complete mandatory training in the managed-self-enrollment talent management system, MSE-TMS. If you have worked at a VA facility before, please let me know so that you may be moved to the New Orleans domain in TMS. You will not need to create a new MSE-TMS account.

You may access the MSE-TMS website to create a new user account at: http://www.tms.va.gov

Please follow the information in the introductory letter located below:

After you’ve completed the training, please print the certificate of completion and return it along with your VA New Resident Application.

Should you have any questions, please contact me at 504-566-8408 or email .

/s/

Janice J. Williams

Administrative Officer

Workforce Development Service

DEPARTMENT OF VETERANS AFFAIRS

Southeast Louisiana Veterans Health Care System

P.O. Box 61011

New Orleans LA 70161-1011

Academic Year 2015-2016 / In Reply Refer To: 629/002C

MEDICO-LEGAL RESPONSIBILITIES OF HOUSE STAFF

Medico-Legal Responsibilities of House Staff under the Federal Tort Claims Act, the Government is liable for the malpractice of its employees acting within the scope of their employment. For purposes of this Act, residents are considered to be employees and 38 U.S.C. 7316 applies; however, because of the variety of conditions and situations which exist, Regional Counsel will be consulted in any situation respecting the adequacy or applicability of malpractice coverage for residents. The following administrative precautions will be exercised (see also 38 U.S.C. 7316, 28 USC 2679, and 38 CFR 14.605). More information may be found here: http://vaww.ogc.vaco.portal.va.gov/law/ftca/default.aspx

Residency members must be informed that they are not protected by the Federal Government in the event of malpractice, negligence, or any other claims against them in consequence of their activities during a period of assignment to non-VA institutions. This notification will be made a matter of record and placed on the left side of each residency member's official personnel folder.

______

Print Name

______

Signature Date

Please complete the attached forms and return with your VA Application

VA Form 10-2850d SF61 VA Form 0711

Please read the attached Numbered Memorandum 00-4 and the SLVHCS Health Professions Trainees Service Orientation Pamphlet and sign the acknowledgement sheets that follow this page. Return these signed pages with the rest of your SLVHCS GME New Resident/Fellow Application.

Your Veterans Health Administration (VHA) virtual library information:

Mail your completed VA New GME Trainee application to:

Southeast Louisiana Veterans Health Care System

Workforce Development Service (002C)

Attention: Ms. Janice Williams

P. O. Box 61011

New Orleans, LA 70161-1011

Please use the checklist to ensure you’ve completed all required forms that need to be returned.

Please return ALL forms to the address below only:

Southeast Louisiana Veterans Health Care System

Workforce Development Service (002C)

Attention: Ms. Janice Williams

P. O. Box 61011

New Orleans, LA 70161-1011

THANK YOU FOR YOUR COOPERATION

You may call me, Janice Williams, at the Southeast Louisiana Veterans Health Care System, Office of Graduate Medical Education, Workforce Development Service, at 504/566-8408, or Crystal Cruz, at 504/566-8416, Monday through Friday, between the hours of 8 a.m. - 4:30 p.m., with any questions you may have and/or for additional assistance regarding this application.