INSTRUCTIONS
FOR
SECTION 2111 APPOINTMENTS
FROM
THE
JULIE ZAMOYSKI
SR. ADMINISTRATIVE ANALYST
A7-44 Rehab
1000 Veteran Ave
Los Angeles, CA
90095-7091
Telephone # (310) 825-7050 or
(310) 825-7059
Fax # (310) 267-2269
PART I To be completed by the Department
PART II To be completed by the Applicant
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to download the entire packet or go to the Forms
page
PART I THE
DEPARTMENT MUST PROVIDE THE FOLLOWING INFORMATION
1. Complete the attached Special Programs 2111/2113 Administrative Processing Sheet
2. Write a letter requesting the Dean’s Office support for a Section 2111. See enclosed sample.
3. Make sure the 2111 Applicant has completed the form and provided the required items. See INSTRUCTIONS FOR THE 2111 PHYSICIAN APPLICANT.
4. Make sure 2111 Applicant, Faculty Sponsor, and Department Chairman sign the Limitations and Restrictions for Section 2111 form.
5. Submit applications in a timely manner.
6. Read the 2111 General Information Sheet.
Please be aware that postgraduate training experience gained
under a Section 2111 Appointment may not be used to meet
ELIGIBILITY
The 2111 Appointment is
for a foreign medical school graduate, who has an appointment with the
LENGTH OF ELIGIBILITY
Section 2111
appointments may be renewed annually for up to 3 years. The Medical Board of
TERMINOLOGY
The international physician shall be known as "Section 2111 visiting fellow".
ACTIVITIES
The Section 2111 visiting fellow may participate in the professional activities of the inviting department.
LIMITATIONS TO ACTIVITIES
The Section 2111 visiting
fellow may NOT write prescriptions, bill patients for services, independently
sign patient charts, serve as a primary care physician, present himself or herself as having a license to practice medicine
in
Postgraduate training
received under the Section 2111 may not be used to meet
All J1 researchers sponsored by UCLA cannot scrub in the Operating Room or assistant in surgeries. They can only observe.
SPONSORSHIP/ SUPERVISION
The 2111 visiting fellow
must be sponsored and supervised by active
Please remember the
State of
2111 Key Issues for Medical Board :
Please be aware that J-1 research visas will further restrict the 2111 appointment. Please call the Visa and Licensing Office at x57050 if you have any questions.
Appointments:
- Appointments are only made after a review of the individual’s credentials
- Are not allowed to do any clinical/patient care till an appointment from the school and approval by the Medical Board is received.
- Each appointee has a specific mentor and one or more supervisors.
- Medical Board likes to call the trainees "Visiting fellows" as they are concerned about supervision and the way the person is perceived by patients.
Teaching:
- May teach in research areas.
- May teach in clinical setting but no action may be taken without the attending/ supervisors input and decision. This is a sensitive issue for Board as they are concerned the interns or residents may take this information and act on it independently.
Patient Care:
- No patient care may occur without received Board approval.
- Only amount of clinical activity and at Medical Center(s) in the original letter of request may be done.
- All clinical activity must be supervised. Level of supervision dependent on the clinic circumstance and level of potential risk. e.g. 1) Anesthesia - must have an attending present at ALL times. 2) Outpatient follow up - can review with the attending after the patient is seen by the Visiting fellow but before any decisions are made or the patient released.
- NO night call.
- Supervisor may be any faculty member who has a current unrestricted license.
- Visiting fellow may write notes, orders or prescriptions BUT must be reviewed, approved and cosigned by the supervisor before any action occurs.
- May only do procedures under Direct supervision and if this was part of the "training" requested in original letter.
Supervision:
- Must be done by faculty with a valid
- Must be on site and likely in room (see above).
- Everything clinical must be cosigned.
- Supervision is most closely aligned to that of a third or fourth year medical student, not at level of an intern, fellow or instructor (regardless of title and education in home country).
- Need to have level of supervision of 2:1 (student / faculty) and the supervisor have adequate availability and time for review.
QA / Discipline:
- There should be no quality concern about the trainee, if so what was done.
- Visiting fellow should be monitored at least at the same level of the interns or others.
- If there were quality issues, these should be Reported and Handled according to the regular QA mechanisms as well as informing the Department and Dean’s office.
Medical Staff:
- Are NOT members of any Medical Staff.
- Cannot obtain medical privileges.
- Cannot work independently or suggest they are independent.
- May NOT directly bill or have their "services" billed for.
Credit:
- May receive a
- No credit for Licensure, Boards or ACGME residency.
Future Plans:
- 2111’s must be renewed yearly.
- Maximum of 3 years, at discretion of Board, upon receipt justification letter from Dean and copy of the ECFMGCertificate, 2 additional years may be approved.
- Need to know the plans of the Visiting fellow after the training and your past experience with your 2111’s.
Overall:
Want guarantee these are quality individuals who are always supervised, never act independently, hold themselves out as licensed physicians, have or are billed for, are adequately evaluated and will be returning to their home country. At a recent site visit to USC the Board’s "major point for discussion included the responsibility in determining the visiting fellow’s intention following the appointment, disciplinary procedures and adequacy of supervision in all patient care areas including night call".
MEDICAL BOARD
2111/2113
Application Submission
Special program applications will no
longer be presented at the Medical Board meetings. Please allow 60-90 day
processing time.
SEND
APPLICATIONS DIRECTLY TO:
Julie Zamoyski,
Dean’s Ofc. A7-44 Rehab
My office telephone number is (310) 825-7050, fax #
(310) 267-2269
Please make sure
signatures have been obtained on the Department request letter before sending the
application to me. Please do not send applications directly to Neil Parker.
INSTRUCTIONS FOR WRITING THE DEPARTMENT LETTER TO REQUEST A SECTION 2111 FOR A FOREIGN PHYSICIAN
Address the letter to:
Dr. Neil H. Parker
Senior Associate Dean, Graduate Medical
Education
Dean’s Office ,
Room 12-138 CHS
Los Angeles, CA 90024
Re: Name of physician
This is to request a Section 2111
appointment for Dr. X , who will be in the
Department of X__________. He will be located at ________. (provide
the name of the campus such as
He will participate in the following activities: (describe in sufficient detail so that the physicians at the Medical Board will understand what the person is doing to patients or volunteers.)
The department chair agrees to ensure that Dr. X____ will be DIRECTLY supervised at all times in patient care activities. Dr. X ______will not be allowed to exceed the limitations of the 2111 exemption. Also, Dr. X______ will be subject to the same disciplinary procedures that are customarily followed in this department.
To ensure that Dr. X _____________ will not
independently write prescriptions, place orders for tests, or hold himself out to be a licensed physician in the State of
In addition, we certify that Dr. X____ will not be in any patient care areas or even incidentally involved in clinical activity until the Medical Board has approved his or her 2111 application.
Sincerely,
Name of Chairperson (or designee)
Title
PART II THE 2111 APPLICANT MUST PROVIDE THE FOLLOWING:
1. See Attached INSTRUCTIONS FOR THE 2111 PHYSICIAN APPLICANT.
2. COMPLETE THE ENCLOSED 2111 APPLICATION FORM.
3. COMPLETE THE SECTION 2111 STATEMENT OF LIMITATIONS. See enclosed form; it should be behind the blank 2111 application form.
4. COMPLETE THE SECTION 2111 STATEMENT OF INTENT. See enclosed form.
5. RETURN THE FORM WITH THE REQUIRED ITEMS TO THE DEPARTMENT THAT WILL BE RECOMMENDING YOU FOR THE 2111. Do not send items directly to the Medical Board or the Dean’s Office.
Please be aware that
postgraduate training experience gained under a Section 2111 Appointment may
not be used to meet
INSTRUCTIONS FOR THE 2111 PHYSICIAN APPLICANT
COMPLETING THE 2111 APPLICATION
FORM
1. Please complete the attached 2111 Application Form. Answer all question blanks. Check YES or NO where appropriate, or write NONE or N/A (not appropriate)
-
Attach 2 photographs (A proof photo is not acceptable.)
- Make sure you sign and date the
application form.
ATTACH THE FOLLOWING ITEMS TO THE FORM
1. A copy of your Curriculum Vitae (same as resume)
2. The original and a copy of
your medical school diploma in the language of your country, along with a
literal word for word English translation, if the diploma is not in
English. The State of
3. A copy of your License to practice medicine issued by your home country, with an English translation. (A translation alone is not sufficient.)
4. If your country does not have a license, a letter from the agency or hospital that gives you the right to practice medicine is required.
5. An original Letter of Good Standing or Certificate of Good Standing, with an English translation, from the Ministry of Health or Medical Council that issued your license to practice medicine. Letters from employers are not accepted. All letters must state that “no disciplinary actions” have been taken against the physician and be dated within the last 90 days.
6. A copy of your Residency Certificate or written verification that you have completed 3 years of basic residency training. The certificate/verification must come from the hospital or facility where the training took place. The certificate/verification should state the dates of training, and if there are multiple training programs, a certificate/verification is needed from each one. If the original language is not in English, an English translation is required.
7. Verification that you are board-eligible, board-certified, or the equivalent in your basic discipline.
8. A signed Section 2111 Statement of Limitations. See attached blank form.
9. A signed Sections 2111 Statement of Intent. See attached blank form.
10. If you are already in the
11. If you are on a J-1 visa, a copy of your DS-2019 form.
12. If you are on another
type of (non-immigrant or immigrant) visa, please provide a copy of the
Approval Notice issued by the US Immigration and Naturalization Service, or
other documents verifying your status such as Resident Alien Card, Employment
Authorization Card, etc.
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