Checklist of Forms to Return to GME by May 11, 2013 Please return the following forms in the stamped self-addressed

envelope
o o o o o o o o o

Licensure/ACSC/DEA Acknowledgement Form IMPACT Policy Acknowledgement Form GME Policies and Procedures Acknowledgement Form BCLS/ACLS Registration Form RSVP for GME Orientation OPR AL Medicaid Application ( only fill out if you have an AL license) CMS-855O Medicare application (all residents need to fill out) Code of Conduct for Professional Behavior Application for Institutional Controlled Substance Permit (only if you do not have your own license) Background Check Infectious Disease Questionnaire GME Information Form Application for Employee Badge Parking Application if applicable Scrubs Order Form Lab Coat Order Form Malpractice Form Transcript printed from the UAB Faculty & Staff Learning System

o o o o o o o o o