M E M O R A N D U M. Graduating and Departing Residents. Aaron Haynes, Director of Graduate Medical Education. DATE: June 1, 2018

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1 M E M O R A N D U M TO: FROM: Graduating and Departing Residents Aaron Haynes, Director of Graduate Medical Education DATE: June 1, 2018 Here are the documents and instructions for completing your Exit Clearance Procedures. Unless you are scheduled to take unused vacation at the end of June, you must work until the end of the month in order to be paid through June 30. Completed GME and UT exit forms will be accepted for clearance in the GME Office to see Toni or Julie, 920 Madison Suite 447, after June 15. (1) GME Exit Clearance Form If you are completing training, a signed copy of your final summative evaluation must be attached to this clearance form. On the 2 nd page, you must obtain clearance from hospitals where you have rotated during your training. If not applicable, write N/A next to each hospital. Note that there is a separate VA clearance form that must be completed. (2) UT Resident Employee Clearance Record Your June paycheck will run on the normal June 30 schedule and will not be released by Payroll to the GME Office until you have completed the Clearance Record. Please note that your final check will be a paper check and will not be direct deposited. This final check will be distributed according to your request on the GME Exit Clearance Form. You do not have to personally visit all of the offices listed on this form. You can call most of them and they will give you a clearance code over the phone. If you do have a financial obligation (parking or library fines), your check will not be released until the fee is paid. Unless your ID expires on June 30, 2018, you will need to personally return your ID to the UT Police Department located at 740 Court Avenue. NOTE: If you are becoming faculty on July 1 and remaining on UT payroll, you do not need to complete this Resident Employee Clearance Record, but you must complete the GME Clearance Form and obtain a new ID card from campus police. Your check should still be direct deposited. If you have a break in service you will need to complete all forms and your check will not be direct deposited. (3) Health Insurance Continuation Form If you are graduating or leaving the University GME Program, you are entitled to keep your health insurance coverage under provisions of the Consolidated Omnibus Budget Reconciliation Act (COBRA). You will be receiving your COBRA enrollment information by mail directly from the Holland Insurance Company. You will be able to keep your coverage for a period of 18 months (or longer in some cases) or until you and all dependents are fully covered under another group plan.

2 Please note that you will be responsible for the full premium rather than the 20% portion that you have been paying as a resident. (4) Disability Coverage You are entitled to keep your individual disability policy at discounted rates. Additionally you are able to upgrade your current policy for an enhanced version with limited to no medical underwriting. If you have not already met with representatives from The Barnett Group, please give them a call at (901) or them at chirag@gobarnett.com OR wes@gobarnett.com. (5) Claims Commission Coverage As a resident you have had immunity under the Tennessee Claims Commission Act rather than commercial liability coverage. We have enclosed a letter explaining this immunity. If you need an individual letter sent to future employers or insurance carriers, please contact us. (6) Account Your UT account stays active for 30 days after leaving the University. If you have set up your UT account to forward to a personal address, you will continue to receive UT s unless you disable the mail forwarding option. You will be removed from the GME listserv by mid-july. (7) NPI Number You are required to update your National Provider Identifier information whenever you change practice locations. If you fail to keep your NPI data current, you may experience problems being recognized by pharmacies and insurers. Log in to the NPI Web site and enter your new practice location address and phone #: You must attach a print out of the updated NPI information in order to clear.

3 The University of Tennessee Health Science Center Resident Employee Clearance Record Name: Personnel #: Forwarding Address: (W2 will be mailed to this address) Program: Title: Home Phone: Term Reason: Term Date: INSTRUCTIONS: An employee terminating or taking a leave of absence without pay is responsible for securing the clearance actions indicated on this form. This completed form needs to be taken to the GME Office at 920 Madison Avenue Suite 447 for final clearance. (GME will forward to Payroll Office for approval.) Activity PROGRAM OFFICE Program Director or Coordinator signs confirm term reason and term date above Books, Tools, Phone Card, Uniforms, Equipment, Keys, etc. LIBRARY ( ) Books, Periodicals, Fees. (Any fines owed to the library must be paid in cash at the Circulation Desk.) PARKING SERVICES ( ) Citations Authorized Activity Outstanding Obligation Representative CAMPUS POLICE ( ) ID Card, Keys CASHIER S OFFICE Fees, Travel Advances, Returned Checks GME OFFICE You turn in the form here. GME will sign and forward to the Payroll Office. I hereby certify that I have cleared all accounts with the University, with the exception of those amounts listed above. Amounts listed above and those accounts not properly cleared by me will be deducted from my final pay. Employee: Date Approved by GME Office: Date Approved by PAYROLL OFFICE ( ): 3/2013

4 GME Exit Clearance Form Instructions: Provide any and all information for future training and/or the type of medical practice you are pursuing. If the complete address is not available, provide the city and state. A signed copy of your final summative evaluation must be attached if you are completing an ACGME program. Per University policy, your final paycheck cannot be direct deposited. Checks are available for pickup on the last working day of the month. Circle how you want to receive your final paper paycheck: 1. Pick up from GME Office 2. Mail to forwarding address below via first class mail 3. Overnight Mail/UPS/FedEx (attach a prepaid, self-address mailer) Demographic Information: Name: Specialty: Forwarding Address: Forwarding Phone Number: Future Plans: Additional Training Specialty: Institution: Address: OR Business/Practice: Address: Private Practice Academic Practice Military Other:

5 Name: GME Exit Clearance Form Page 2 Signatures Required: If you have never trained in a hospital listed below, please indicate with N/A next to those hospitals. Otherwise you must secure each of the signatures listed below. Baptist Hospital Cleared by GME Office with approval from Regina Rogers. Methodist/Lebonheur Healthcare Medical Records See the attached handout or the link below for directions. A clearance must be attached. UT GME will collect your Methodist ID and keys for you or you may return them directly to Methodist. Regional One Health 1. Health Information Management (HIM) (1 st Floor Chandler) HIM sign-off Date Make sure all medical records are dictated and signed prior to reporting to HIM HIM Team: Keesha ; Buffy ; or Cynthia Bring your ROH badge and any ROH scrubs (laundered) to the following location for final sign-off: Brad Jordan or Sheri Yendrek Madison 1 st Floor 1C01 MedPlex sign on door says Medical Staff Services, directly across from the public restrooms; or Badge Returned: YES NO Scrubs returned? YES NO NA How many scrub pairs returned? ROH sign-off Date Staff available between 8:00-4:00 M-F. VA Medical Center Specialty Service Office Education Service Office The VA has their own exit clearance form. Please attach a copy of their completed form. Program Director (Note that unused vacation days must be available if resident/fellow leaves prior to termination date.) The resident has returned all equipment and obligations to the training program. If the resident/fellow is completing an ACGME training program, you must attach a copy of the final summative evaluation. Signature: Date:

6 Methodist Healthcare Resident Check Out Electronic Check-Out Process Residents may obtain medical record clearance via . Prior to medical record release, completion of outstanding record documentation(s) and order(s) is required. To request electronic verification of record completion, submit an request to PJ Hayes, Methodist Healthcare Health Information Management with a copy to your program coordinator. HIM: P Hayes p.hayesmlh.org Phone: HIM Associates will verify record status and respond to the resident within 48 hours of receipt. Reply will be sent to the resident and program coordinator. Residents will be informed of record completion status as either: a) Complete release approved for Methodist Healthcare Health Information Management (adult and e Bonheur facilities) Or b) Outstanding records and/or orders -- please log in to your in-box in message center and complete; or call the HIM department at: for assistance. e are unable to provide electronic list of outstanding encounters. (See General Information for Methodist Healthcare resident record completion on next page)

7 General Information for Residents - Record Completion All residents completing the program should process through HIM for clearance. All orders unsigned documents and documents for review will need to be addressed. For documents that are not accessible in your Message Center in-box, you will need to open the document in Power chart and sign directly on the document. If your attending has not signed, you will need to forward the document to your attending for their signature. If there are documents saved in your inbox, they will also need to be forwarded to correct attending for signature. If you are unable to complete deficiencies either in your inbox or directly on the document in PowerChart, please maintain a copy of the list and submit to HIM for further research. If you made calls and were unable to produce positive results, please write this on the pull list so efforts will not be duplicated. If your computer access privileges have lapsed, you will need to contact IS and have their password reset. Number: