NOTE: This checklist is an example of the types of documents/tasks that can be completed electronically in advance of a new resident’s starting date. State licensing agencies differ, so it is important that you contact the licensing agency in your state to determine their requirements. Likewise, each hospital/sponsoring institution will have its own unique forms, requirements, etc so you must also check with your DIO/GME Office to assure compliance per your institution.

Onboarding Checklist – Unless otherwise stated, checklist items are due no later than 5/31. 2016
Welcome to the Southern Regional AHEC Family Medicine Residency Program! To expedite credentialing and orienting you to the program, this checklist will detail requirements. Note that it is extremely important that you access this checklist on a regular basis and follow the steps as instructed. Failing to follow instructions and missing deadlines will adversely affect your credentialing and could result in delaying the start of residency. If at any time you have questions, please do not hesitate to contact Cheryl Haynes, Residency Manager, at 910-678-7259 or .
Reimbursement of NC RTL fee
SR-AHEC will reimburse you the cost of the NC RTL if it is received by June 30th. Please upload your receipt here.
Contract
Please print, sign and upload your contract.
NC License Application
Using the link provided, you are required to submit an application for a resident training license. Your application will be assigned a file number. Following the instructions in this application is crucial. Errors and omissions can delay receipt of your license and subsequently your matriculation into residency. Remember that per your contract, SRAHEC will not reimburse you for the cost of your RTL if you have not received it by June 30th. Print each form and follow the instructions for each one. Some will require submission to SR-AHEC, others will require submission to the NCMB. The appointment letter will be prepared and submitted by SR-AHEC.
IHI Courses
Log into the IHI website and complete the courses. Complete PS 100, PS 101, PS 102 and PS 103 by May 30, 2016. Note that there is no fee for taking these courses.
Federal Income Tax
Please complete, sign and upload the attached federal W-4 form. If you are unsure of how to complete it and need assistance, you may contact Kaye Williams, SRAHEC Human Resources Assistant, at 910-223-0646.
Order your USMLE or COMLEX score reports!
The score reports must be sent directly from the reporting authority to the NC Med Board. Strongly recommend that you do this immediately.
Current BLS certification is required prior to the start of your residency.
You may upload your current certification card on this site. - OR - If you do not have current certification and have to take a course, you may take the American Heart Association online course, HeartCode® BLS Part 1. A link is available below. You will have to create a user name and password. SR-AHEC will reimburse you for the cost of the certification, provided that you submit original receipts and have certification dated prior to June 20, 2015. Note that the online course is only part of the certification.
Physical Exam - DO residents only
Per AOA Requirements, you are required to submit documentation of a physical examination prior to starting your residency training. You may upload that document(s) here. The deadline for submitting this document is June 17, 2016.
CFVHS Confidentiality Agreement
Sign and upload this form.
Establishing your NPI number
The National Provider Identifier is a number unique to you as a health care provider and will follow you for the rest of your career. Complete the attached form so that I can apply for your NPI numbers. Know that once established, the user name can never be changed.
State Income Tax
Please complete, sign and upload the attached state W-4 form. If you are unsure of how to complete it and need assistance, you may contact Kaye Williams, SRAHEC Human Resources Assistant, at 910-223-0646.
Malpractice Insurance Application
Please complete, sign and upload the application for MagMutual Malpractice Insurance. Note that while many of these questions will not apply to you as a new resident, you cannot leave a question unanswered. So be sure to answer "N/A" when appropriate. Also:
Question 1 - the requested coverage date is the resident's first day here with us:
June 27th
Question 9 - just put N/A
Question 15 – NO
Questions 10 -14 - put NO for each
Make sure all of the 1st, 2nd and 3rd pages are entirely completed, and signatures are on Page 6 in 3 places (where the first three 'x"s are located).
Computer Access Form
Download, complete and upload this form back into New Innovations.
NOTE: Make sure that all forms are signed and the password submitted is legal, i.e. no part of the user or practice name, no obvious patterns and at least 8 characters in length.
Required Hospital Orientation
Complete both the Corporate Compliance and the Abbreviated Hospital Orientation modules at the website listed below. The password is: 1638owen Print your completion certificates and upload them here.
Email and Internet Access
Download, read, sign and upload the attached document.
Immunizations
A copy of your immunization record (including MMR, Hepatitis B, Varicela and TDAP) is required prior to beginning residency. You may upload a copy here. Note that you will be given a TB skin test during orientation.
Emergency Contact
Please complete, sign and upload this form.
Direct Deposit
Please download, complete and upload the attached form. NOTE: You must also upload a voided check on the account you are designating for direct deposit.
Disclosure Release Form
Download, complete and then upload the Disclosure Release form.
SRAHEC Employment Application
Please complete, sign and upload this form.
Acceptable Forms of Identification
On your first day at SRAHEC, you will be required to complete an I-9, Employment Eligibility Verification. To complete this form, you will have to provide proof of identity. The attached document provides a list of the documents that will be accepted for this purpose. NOTE: YOU MUST HAVE THESE ORIGINAL DOCUMENTS WITH YOU ON YOUR FIRST DAY. IF YOU DO NOT HAVE THE ORIGINAL DOCUMENTS, YOU WILL BE SENT HOME. Double check the list of approved forms now so that if you are going to have to obtain a copy of your birth certificate, you will have time to do so. Pay close attention to the "or" and the "and".
Required SR-AHEC Employee Courses (Compliance, Safety, Bloodborne Pathogens, HIPAA, etc.)
These online courses must be completed prior to June 27, 2016.