Affiliation Agreements - GME

Flowchart for New and Renewing Affiliations

Guide for Selecting the Correct Affiliation Template

Request for Affiliation

• EXAMPLE of Completed Form

Standard Affiliation Agreements

• Standard Affiliation Agreement Template with reimbursement
• Standard Affiliation Agreement Template without reimbursement

Non-Standard Affiliation Agreements

• Non-Standard Affiliation Agreement Template with reimbursement
• Non-Standard Affiliation Agreement Template without reimbursement

Johns Hopkins University/Hospital

• Johns Hopkins University/Johns Hopkins Hospital
  (Use for UMMC's residents/fellows rotating AT Hopkins)
• The University of Maryland Medical Center/University of Maryland School of Medicine AND The Johns Hopkins University
  (Use for JHU's residents/fellows rotating AT UMMC)

Mercy Affiliation Agreements

• Mercy Affiliation Agreement Template (Emergency Medicine/Pediatrics/Anesthesiology/Dermatology) with reimbursement
• Mercy Affiliation Agreement Template (Emergency Medicine/Pediatrics/Anesthesiology/Dermatology) without reimbursement
• Mercy Affiliation Agreement Template (Other) with reimbursement
• Mercy Affiliation Agreement Template (Other) without reimbursement

State Institution Affiliation Agreements

• State Institution Affiliation Agreement Template with reimbursement
• State Institution Affiliation Agreement Template without reimbursement

VA Affiliation Agreements (use same agreement with or without reimbursement)

• VA Affiliation Agreement

Private Office Agreement Template without reimbursement

Children's Hospital Agreement Template without reimbursement

Integrated Addendum

Rotator Agreements

• Rotator Agreement Standard (other institution provides malpractice)
• Rotator Agreement MedStar
• Rotator Rider JHH/JHU (Use for Hopkins's residents/fellows rotating AT UMMC)
• STAPA Rotator Standard (other institution provides malpractice)
• STAPA Rotator Canadian