PART ONE: All forms must be completed using your legal name as indicated on your Social Security Card and returned by

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NOTE: The Health Statement below requires a physical exam, supporting documentation for TB Skin Tests, labs & vaccinations.  Please plan on meeting the requirements prior to your start date and while you still have access to healthcare.

 

Print, complete legibly and mail all forms to:


UCSF Fresno Center

Attn:  Human Resources

155 N. Fresno Street, #266

Fresno, CA 93701

 

Abuse Reporting Form

Nonresident Alien Forms (if applicable)

UC W8BEN

UC W4NR

UC W4NR Instructions

SSN & DMV Timing

Badge Request Form

Social Security Statement

Demographic Data Transmittal

UC W-4/DE 4 (Leave Address Blank)

Designation of Beneficiary

Scrub Suit/Lab Coat Order

Direct Deposit

Vehicle Registration

Domestic Partnership Forms (if applicable)

Postgraduate Training Registration Form
(for MDs only)
(Instructions for PTRF)

Health Statement

Media and Public Relations Authorization

HIPAA Confidentiality Statement

UCSF Fresno Email Account

Medical Insurance Enrollment Form
(Leave Address Blank)

Duty Hours Acknowledgement

Medical Insurance Declination
(if applicable)

Handbook Availability Acknowledgement

National Provider Identification Number
(please send back a copy of your confirmation
e-mail from NPPES)

Release of Information

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PART TWO: Training Modules— Required for all incoming housestaff
by

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  • Please view each module and take the corresponding quiz. Your successful completion of each quiz will be recorded electronically for UCSF Fresno. 
  • Please print a copy of the completion certificate for your own records.

Fatigue/Sleep Deprivation Video
  Windows Media Format
  MP4 / Mac Friendly Format
  Flash Format

Fatigue/Sleep Deprivation Quiz
Account name: fatigue, no password required 

HIPAA

HIPAA Quiz
Account name: hipaa, no password required

Infection Control

Infection Control Quiz
Account name: infection, no password required

Substance Abuse in Physicians
  Windows Media Format
  MP4 / Mac Friendly Format
  Flash Format

Substance Abuse Quiz
Account name: sa, no password required

Quality/Risk/Safety
  View Video

 

Quality/Risk/Safety Quiz

Account name: quality, no password required

Fire/Life Safety Training Sheet

Two Courses in Legal Medicine

 
  • Informed Consent I (Pediatric Residents take “Minor Consent”)

  • Supervision of Residents & Assistants I

 

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  Click Here

 

 

PART THREE: BLS & ACLS

With the exception of Pediatric residents, all housestaff are required to be certified in BLS & ACLS prior to your first day of work and will be required to maintain this certification throughout your training.  Information regarding PALS will be mailed to Pediatric residents directly from the program office.

 

  • You must provide copies of your BLS & ACLS certification cards with the rest of your required forms.  Keep in mind that certification must be from an American Heart Association course.  Non-receipt of these certifications will delay your start date!

 

PART FOUR: General Information

You are responsible for information contained in these links, so please take the time to carefully review the information.

Insurance Comparison

Benefits: Medical, Dental, Vision, Life, AD&D

HIPAA Handbook

Leave Policy

License Information

Retirement Savings Program (Monthly 7.5% Mandatory Contribution)

State Oath & Patent (Please read this policy in advance and expect to sign this form at Orientation) 

UCSF Fresno Housestaff Handbook