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Patient care and medical education must be the highest professional responsibility of the house officer. The House Officer and Program Director are also responsible to ensure compliance with both the letter and the spirit of the ACGME Duty Hours regulations. The Program Director may set guidelines that allow qualified house officers to moonlight. If the Program allows moonlighting, it is the responsibility of the Program Director to ensure compliance with Duty Hours regulations and Duty Hours Tracking.
Internal Medicine categorical residents who wish to moonlight must comply with the following:
It is the responsibility of the resident to inform the Program Director of his or her intention to moonlight and to ensure that the 80 hour work week rule and other Duty Hours regulations are adhered to.
Permission may be requested by completing the Moonlighting Policy Acknowledgment / Application Form from the Residency Office and submitting it to the Internal Medicine Residency Office. The Program Director will review requests. The house officer may not begin to moonlight until after receiving written consent from the Program Director. Consent can be removed at any time if the house officer fails to maintain the standards set forth above.
Violations of this policy will be dealt with in the Competence Committee. Any house officer discovered to be moonlighting without permission or to be moonlighting more than the approved number of hours or at an unapproved site may be subject to disciplinary action up to and including probation and dismissal. House officers approved for moonlighting must file a Moonlighting Activity Tracking Form.
The University and School of Medicine malpractice insurance plan does not cover moonlighting activities.
Name _________________________________ Block ________ Dates of Block _______________
I am authorized by the ROC to moonlight for _________ hours per week, at the following location(s) as long as total hours per week in any single week in the residency and at moonlighting do not exceed 80, and I am not on an inpatient ward, ICU, or CCU rotation, regardless of the total hours worked.
Location 1 _____________________________________________________
Location 2 _____________________________________________________
Location 3 ______________________________________________________
I certify that during the block just ended, I have moonlighted on the following schedule, reflected in the table below. I further certify that I have not worked more than 24 continuous hours during this period of time and that my total hours worked have not exceeded 80 in any single week. I understand that my primary work obligation is to my residency program and my education.
Attach a copy of the official schedule.
Date |
Location # |
Total Hours Moonlighting |
Comments |
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___________________________________________ ___________________
Signature Date
PD Initial [ ]
UCI Department of Medicine Internal Medicine Residency Program Moonlighting Policy Acknowledgment And Application Form |
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I wish to begin moonlighting at the following location and hours per month:
____________________________________________________________________________________________ Location #1 Responsibilities Hrs/Wk
_____________________________________________________________________________________________ Location #2 Responsibilities Hrs/Wk
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_____________________________________________________________________________________________ NAME (Print) SIGNATURE DATE
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ADMINISTRATIVE SECTION- DO NOT FILL OUT
CONFERENCE ATTENDANCE ________ STATUS ___________ INTRAINING SCORE _________%tile
_____________________________________________________________________________________________ PROGRAM DIRECTOR SIGNATURE DATE
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