PROGRAM LETTER OF AGREEMENT

This Program Letter of Agreement is the residency training affiliation agreement between the Sponsoring Institution and the Participating Site with respect to a clinical training experience for the Sponsoring Institution’s assigned residents, and the agreement of the parties to abide by all terms and conditions of the AAMC Uniform Terms and Conditions dated January 22, 2018, which is hereby incorporated by reference, without modification or exception except as specified below.  Any conflict between this Program Letter of Agreement and the AAMC Uniform Terms and Conditions are to be interpreted in favor of this Program Letter of Agreement.

This Program Letter of Agreement is effective from _____/_____/_______, and will remain in effect for five years or until updated or changed by the Sponsoring Institution and the Participating Site or terminated by either party.

1.	Parties

Sponsoring Institution: Board of Regents of the University System of Georgia on behalf of Augusta University, Medical College of Georgia

Participating Site:

2.	Persons Responsible for Education and Supervision

Program Director at Sponsoring Institution:

Site Director at Participating Site:

Other faculty at Participating Site (by name or general group):

The above named people are responsible for the education and supervision of the residents while rotating at the Participating Site.

3.	Responsibilities

The faculty at Participating Site must provide appropriate supervision of residents in patient care activities and maintain a learning environment conducive to educating the residents in the competency areas identified by ACGME or other applicable accrediting bodies.  Supervision must provide safe and effective care to patients; ensure development of skills, knowledge, and attitudes required to enter the unsupervised practice of medicine and establish a foundation for continued professional growth. The faculty must evaluate resident performance in a timely manner during each rotation or similar educational assignment and document this evaluation at the completion of the assignment.

4.	Goals and Objectives of the Educational Experiences

The goals and objectives of the educational experiences have been developed according to ACGME Residency Program Requirements or other applicable accrediting bodies, and include the following goals and objectives based on training year and the below ACGME Core Competencies.

Medical Knowledge 		
Patient Care 		
Systems-Based Practice		
Practice-Based Learning and Improvement		
Professionalism		
Interpersonal and Communication Skills		

The Program Director, Site Director and the program faculty at the Participating Site are together responsible for the day-to-day activities of the residents during the course of the educational experiences at the Participating Site in furtherance of the goals and objectives.

5.	Policies, Rules and Regulations that Govern Resident Education

Residents will be under the general direction of their Sponsoring Institution Program’s Policy and Procedure Manual regarding educational matters as well the Participating Site’s policies, rules and regulations regarding patient care activities.

6.	Financial Responsibility

Sponsoring Institution shall employ the residents and is responsible for the payment of any salary and compensation to the residents, as well as providing or requiring health insurance coverage and workers compensation coverage, and withholding all applicable taxes.  Sponsoring Institution understands that its residents will not be covered by or entitled to any social security, unemployment compensation, retirement, pension and/or any other benefits programs or workers’ compensation program offered or provided by Participating Site, and no resident shall have any right, title or claim to participate in the same.  

7.	Other Modifications or Exceptions to the AAMC Uniform Residency Training Terms and Conditions

Modifications or Exceptions (if none, please indicate by writing “none”):

The individuals executing this program letter of agreement are authorized to sign on behalf of the below entities and certify that their entities have accepted the AAMC Uniform Terms and Conditions for Program Letters of Agreement and further agree to comply with its terms except as noted above.

Sponsoring Institution:	Board of Regents of the University System of Georgia on behalf of Augusta University, Medical College of Georgia 

By: David C. Hess, M.D.		Signature: ____________________________
     
Title: Dean, Medical College of Georgia     

Program Director: _________________________
 
Date: _________________________	

Address:	1459 Laney Walker Blvd.
Augusta, GA 30912

By: Natasha M. Savage, MD	Signature: _________________________

Title: DIO, Medical College of Georgia		 

Date: _________________________

Participating Site:	_______________________________________

By: ____________________________	Signature: _________________________

Title: _________________________ Site Director: _________________________		 
Date: _________________________

Address:	___________________________

		___________________________

By: ____________________________	Signature: _________________________

Title: DIO of Participating Site (if applicable) 		 
Date: _________________________