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  1. University of Arkansas for Medical Sciences
  2. College of Medicine
  3. Graduate Medical Education
  4. Supplemental Clinical Activity (SCA) Request

Supplemental Clinical Activity (SCA) Request

Prior to completing this form, please review UAMS COM GMEC 3.310 Guidelines for Supplemental Activity This online form must be completed by the Program Director or Program Coordinator.

In order to complete this process, you will need to:

  1. Download the Resident/Fellow Acknowledgment Form, obtain signatures and upload the signed form.
  2. Upload documentation showing approval from SCA department business administrator for the requested SCA.
    • It is the responsibility of the department to ensure SCA pay and UAMS salary does not exceed the Arkansas State line-item maximum ($97,605).

GME provides approval for educational purposes only.

Residents and fellows are NOT authorized to begin supplemental clinic activities until Program Director has received approval from the Designated Institutional Official. The GME Office will provide confirmation of the approval to the program.

Please allow up to THREE weeks for the processing of Supplemental Clinical Activity requests.

Supplemental Clinical Activity Request Form

Name of Program Director or Program Coordinator submitting SCA Request(Required)

Is this request for a group of trainees or an individual trainee?(Required)
List Each Individual of the Group
Trainee's Name
PGY Level
Are they a US citizen?
Visa status if not US citizen
Email
 
Trainee's Name(Required)
Are they a US Citizen?(Required)

Approval is granted for 12 months or less during a single academic year (July 1 – June 30)
SCA Departmental Administrative Contact Name(Required)
EX: Number of times SCA will occur, number of hours worked during a SCA, number of days worked.
Max. file size: 15 MB.
Max. file size: 15 MB.
Max. file size: 15 MB.
PD Approval(Required)
By checking the box below the Program Director:
1) approves this supplemental clinical activity request;
2) agrees to monitor this housestaff officer for educational effect of this activity;
3) agrees to monitor work hours logged in New Innovations for duration of SCA; and
4) agrees to withdraw approval if necessary.
Do not submit without complete and proper documentation. Incomplete forms will not be processed.(Required)

Please allow up to THREE weeks for the processing of Supplemental Clinical Activity requests.

UAMS College of Medicine LogoUAMS College of MedicineUniversity of Arkansas for Medical Sciences
Mailing Address: 4301 West Markham Street, Little Rock, AR 72205
Phone: (501) 686-7000
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