Answer the following questions (answer YES or NO) for the proposed FMP site(s) only. Make sure that you FMP Site FMP Site FMP Site FMP Site FMP Site complete the correct column. #1 #2 #3 #4 #5 1. Does the entry to the FMP site have YES YES YES YES YES signage that clearly identifies it as an NO NO NO NO NO FMP site? 2. Does the residency program director YES YES YES YES YES have control of the educational NO NO NO NO NO activities in the FMP site? 3. Does the residency program director YES YES YES YES YES have control of the activities of the NO NO NO NO NO support personnel in the FMP site? 4. Does the director of the FMP site YES YES YES YES YES report to the program director? NO NO NO NO NO 5. Does the appointment system ensure YES YES YES YES YES maximum accessibility of the resident NO NO NO NO NO to his/her patients in the FMP site? 6. Is there a business office or business YES YES YES YES YES function area in the FMP site? NO NO NO NO NO 7. Is there a conference room at this YES YES YES YES YES FMP site large enough to NO NO NO NO NO accommodate the residents, faculty members? 8. Do FMP site patients have convenient YES YES YES YES YES access to imaging services? NO NO NO NO NO 9. Do FMP site patients have convenient YES YES YES YES YES access to a diagnostic laboratory? NO NO NO NO NO 10. Do FMP site patients have access to a YES YES YES YES YES program physician after hours? NO NO NO NO NO 11. Do family physician faculty members YES YES YES YES YES see patients without residents in the NO NO NO NO NO FMP site? Explain any NO responses. Describe in detail any activities that take place in the FMP site that are not family medicine If other specialties are located on the same floor of the facility, explain and indicate on the floor plan how the FMP is a discrete unit that is separate from these areas. Specify any other space that is not part of the FMP site that is currently allocated for administrative offices, conferences, etc., for residents/faculty members assigned to this FMP site.
Answer the following questions (answer YES or NO) for the proposed FMP site(s) only. Make sure that you complete the correct column. FMP Site #1 FMP Site #2 FMP Site #3 FMP Site #4 FMP Site #5 1. Does the entry to the FMP site have signage that clearly identifies it as an FMP site? YES NO YES NO YES NO YES NO YES NO 2. Does the residency program director have control of the educational activities in the FMP site? YES NO YES NO YES NO YES NO YES NO 3. Does the residency program director have control of the activities of the support personnel in the FMP site? YES NO YES NO YES NO YES NO YES NO 4. Does the director of the FMP site report to the program director? YES NO YES NO YES NO YES NO YES NO 5. Does the appointment system ensure maximum accessibility of the resident to his/her patients in the FMP site? YES NO YES NO YES NO YES NO YES NO 6. Is there a business office or business function area in the FMP site? YES NO YES NO YES NO YES NO YES NO 7. Is there a conference room at this FMP site large enough to accommodate the residents, faculty members? YES NO YES NO YES NO YES NO YES NO 8. Do FMP site patients have convenient access to imaging services? YES NO YES NO YES NO YES NO YES NO 9. Do FMP site patients have convenient access to a diagnostic laboratory? YES NO YES NO YES NO YES NO YES NO 10. Do FMP site patients have access to a program physician after hours? YES NO YES NO YES NO YES NO YES NO 11. Do family physician faculty members see patients without residents in the FMP site? YES NO YES NO YES NO YES NO YES NO Explain any NO responses. Describe in detail any activities that take place in the FMP site that are not family medicine If other specialties are located on the same floor of the facility, explain and indicate on the floor plan how the FMP is a discrete unit that is separate from these areas. Specify any other space that is not part of the FMP site that is currently allocated for administrative offices, conferences, etc., for residents/faculty members assigned to this FMP site.
FMPSiteProposal.docx