Role of Fellow in Care of Patients - List the 5 Estimated Average Designate most Average # # of as: common of new follow-up Primary patient Location of # of patients patients Provider diagnoses Experience Duration of Sessions per fellow per fellow (PP) encountered Use Site/Other Setting Experience per week per per in this Identifier (in wks/yr) per fellow session session (C) setting PP C PP C PP C PP C PP C PP C PP C PP C Conferences 1. List regular subspecialty and interdepartmental conferences, rounds, etc. that will be a part of the program. Identify the "SITE" by using the corresponding number as appears on the first and second pages of this form. Indicate the frequency, e.g., weekly, monthly, etc., and whether conference attendance is required (R) or optional (O). List the role of the fellow in this activity (e.g., conducts conference, presents case and participates in discussion, case presentation only, participation limited to Q&A component, etc.). Add rows as necessary. [PR IV.A.3.g]
Location of Experience Use Site/Other Setting Identifier Duration of Experience (in wks/yr) # of Sessions per week per fellow Estimated Average # of new patients per fellow per session Average # of follow-up patients per fellow per session Role of Fellow in Care of Patients - Designate as: Primary Provider (PP) (C) List the 5 most common patient diagnoses encountered in this setting PP C PP C PP C PP C PP C PP C PP C PP C Conferences 1. List regular subspecialty and interdepartmental conferences, rounds, etc. that will be a part of the program. Identify the "SITE" by using the corresponding number as appears on the first and second pages of this form. Indicate the frequency, e.g., weekly, monthly, etc., and whether conference attendance is required (R) or optional (O). List the role of the fellow in this activity (e.g., conducts conference, presents case and participates in discussion, case presentation only, participation limited to Q&A component, etc.). Add rows as necessary. [PR IV.A.3.g]
338_PediatricTransplantHepatology_1-YR.docx