Get the free SECONDARY APPOINTMENT CHECKLIST

SECONDARY APPOINTMENT CHECKLIST Case Western Reserve University School of Medicine Submit all materials to: somFacultyApptMaterials@case.edu Forms, templates, & more detail: https://case.edu/medicine/facultystaff/facultyaffairshrCandidate:

How to fill out secondary appointment checklist

How to fill out secondary appointment checklist

1. Obtain a copy of the secondary appointment checklist form.
2. Fill in the patient's information at the top of the form, such as name, date of birth, and medical record number.
3. Check off the applicable items on the checklist to indicate which services or tests are needed for the appointment.
4. Provide any additional information or notes in the designated space on the form.
5. Review the completed checklist for accuracy and completeness before filing or submitting it.

Who needs secondary appointment checklist?

1. Patients who have scheduled a secondary appointment with a healthcare provider.
2. Healthcare providers who need to ensure all necessary services are provided during a secondary appointment.

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What is secondary appointment checklist?

The secondary appointment checklist is a document used by individuals holding multiple appointments within an organization to ensure compliance with reporting requirements and to facilitate the review process of their additional roles.

Who is required to file secondary appointment checklist?

Individuals who hold secondary appointments at academic institutions, particularly faculty and staff members, are typically required to file the secondary appointment checklist.

How to fill out secondary appointment checklist?

To fill out the secondary appointment checklist, individuals need to provide personal information, details about their primary and secondary appointments, and relevant disclosures as required by the institution.

What is the purpose of secondary appointment checklist?

The purpose of the secondary appointment checklist is to streamline the approval process for additional appointments, to ensure transparency, and to maintain compliance with institutional policies.

What information must be reported on secondary appointment checklist?

The information that must be reported includes the individual's name, primary appointment details, secondary appointment details, time commitment, and any potential conflicts of interest.