The Graduate Medical Education (GME) Credentialing Checklist outlines all the required documents and forms for resident/fellow rotators (also listed below). Follow the links to complete the required forms and view the Inova training documents.
*Please note: The GME forms can be completed electronically. Simply download and save each form and select the ‘Add Text’ option under ‘Sign’ to complete the form. Once you have completed the form, select the ‘Place Signature’ option under ‘Sign’ to sign the form.
Please email all required forms to GME Credentialing or fax to 703-776-3201 if you are unable to complete the forms electronically. If you have any questions, please contact the GME Office at 703-776-2626.
To Be Provided by Resident/Fellow and/or Institution
- Complete Academic Year Rotation Schedule (must include institution name, resident/fellow legal first and last name, PGY level, name of rotation being completed and location of rotation)
- Application to the Program (ERAS or other; military residents/fellows provide PCS orders)
- Updated CV listing your current residency/fellowship program and dates
- Fully Signed Resident/Fellow Employment Agreement (For the current academic year)
- Active Virginia Medical Training License
- ECFMG Certificate (if applicable)
- NPI Number Verification
- Current ACGME Procedure Logs (For Orthopedic Residents ONLY)
To Be Completed by Resident/Fellow
- GME Credentialing Demographic Form
- Confidentiality and Non-Disclosure Agreement for Physicians
- Influenza Vaccine Verification 2023-2024 (Required for rotators on-site between November 1 – March 31)
- Prescription Monitoring Program (PMP) Registration Confirmation (Instructions on Completing PMP Registration)
- Inova Alerts Sign-Up Instructions
- Inova Alerts Attestation
In order to be able to prescribe certain medication to patients, Virginia now requires our office to verify prior to you starting your rotation here at Inova Fairfax Medical Campus. To ensure compliance with Virginia requirements, you must submit the following items to the GME Office in addition to the above required credentialing documents:
- Electronic Prescribing of Controlled Substances (EPCS) Identity Verification Form (If not previously submitted)
- Clear copy of Non-Expired Government Issued Photo ID
HealthStream Training
Required HealthStream training modules are assigned by the GME Office after resident/fellow paperwork is received and processed:
- Epic Training (if not previously completed)
- iMed Consent for Providers (if not previously completed)
- Annual Education for Acute Care Clinical Staff
- Equal Access: Language and Disability Services