ࡱ> + Xbjbj 8DhDhP""8lF&<<<+ + + tFvFvFvFvFvFvF$HKJF$!+ + $!$!F<<F4$4$4$$!j<<tF4$$!tF4$4$R@B<1!BA`FF0FAL"L<BLB+ >i ,4$ $ k+ + + FF#+ + + F$!$!$!$!L+ + + + + + + + + "X z: RESIDENT/FELLOWSHIP AGREEMENT OF APPOINTMENT THIS RESIDENT/FELLOWSHIP AGREEMENT OF APPOINTMENT (this "Agreement") is made and entered into by and between The University of Toledo an instrumentality of the state of Ohio created under Chapter 3364 of the Revised Code, located at 3000 Arlington, Toledo Ohio 43614 (ý) and _________________________ ("Resident/Fellow"). ý and Resident/Fellow are individually a "Party" and collectively the "Parties". ý operates a Graduate Medical Education Program (hereinafter Program) with the cooperation of the University of Toledo Medical Center (UTMC), certain associated hospitals, and other health care institutions (Participating Sites). Resident/Fellow is hereby appointed as a post-graduate participant in the Program and offered the educational experience hereunder which is approved by the Accreditation Council for Graduate Medical Education or other applicable accrediting body (Accrediting Body) or other non-accredited programs as designated and approved by ý. Resident/Fellow Responsibilities. While providing clinical services hereunder and participating in the Program, the Resident/Fellow will: Comply with and adhere to the policies, practices, rules, bylaws, and the regulations of the Program, of the Graduate Medical Education Committee of ý (hereinafter GMEC) and of the policies of ý and of all Participating Sites to which Resident/Fellow rotates. Comply with and adhere to all applicable state, federal, and local laws, as well as the standards required to maintain accreditation by The Joint Commission, Accrediting Body, the Review Committee (hereinafter RC), and any other relevant accrediting, certifying or licensing organizations. Comply with the requirements of Ohio Ethics law that apply to employees of ý, including but not limited to Sections 102.03, 102.04 and 2921.42 of the Revised Code. Participate fully in the educational and scholarly activities of the Program, including, but not limited to, the performance of research activities as assigned by the GME program director (Program Director) or as necessary for the completion of applicable graduation requirements, attend all required educational conferences, assume responsibility for teaching and supervising other Resident/Fellows and students, and participate in assigned Participating Sites Medical (and Dental) Staff committee activities. Fulfill the educational requirements of the Program as determined solely by the Program. Provide safe, effective and compassionate patient care and present at all times a courteous and respectful attitude toward all patients, colleagues, employees, and visitors of the Participating Sites to which the Resident/Fellow is assigned. Provide clinical services commensurate with Resident/Fellows level of training under appropriate supervision as approved by the Program in circumstances and at locations included in the Program covered by ýs professional liability insurance policies maintained on behalf of the Resident/Fellow. Fully cooperate with the Program and ý in coordinating and completing RC and Accrediting Body accreditation submissions and activities, including the legible and timely completion of patient medical/dental records, charts, reports, logging of clinical and educational work hours, statistical operative and procedure logs, faculty and Program evaluations, or other documentation required by the RC, Accrediting Body, Participating Sites and Program. Fully cooperate with all Participating Sites and ý surveys, reviews, quality assurance and credentialing activities. Apply cost-containment measures in the provision of patient care consistent with the policies of the Participating Sites or Program. Meet Participating Sites and applicable state standards for immunizations at all times. Maintain during this Agreement, Basic Life Support certification. (The cost of Basic Life Support training will be borne by ý.) Comply fully with ý's policies regarding equal opportunity, nondiscrimination, and accommodation of disabilities and report any suspected violations in accordance with those policies. Fully cooperate with ý personnel, agents or officials, including but not limited to attorneys, compliance officers, investigators, committees or departments of ý in any claim or situation that may arise that results in an investigation, legal matter or issue that ý determines requires Resident/Fellows cooperation. This provision will survive expiration or termination of this Agreement. Provide to the GMEC and authorize the GMEC to properly disseminate, including to Participating Sites, any and all information required by law or by any accreditation organization. Return all ýs and Participating Sites property including, but not limited to, books, equipment, paper, uniforms, identification, and keys; complete all necessary records; and, settle all professional and financial obligations upon the expiration or termination of this Agreement. Duration of Appointment/Terms of Appointment. It is understood that Resident/Fellow serves as an unclassified employee at the pleasure of ý. Resident/Fellow's appointment is as follows. Position: Post Graduate Year: Program: Program Training Level Designation: Commencement Date: Expiration Date: As a condition precedent to appointment and a condition subsequent, the Resident/Fellow must provide all appropriate credentialing documentation as required by the Program and submit through the residency management software designated by the Program prior to the Commencement Date set forth above and ý must approve this documentation in order for this Agreement to be binding on ý. Any document required hereunder not provided in English must be accompanied by an original English translation performed by a qualified translator and acceptable to ý. Each translation must be accompanied by an affidavit of accuracy acceptable to ý. RESIDENT/FELLOW REPRESENTS AND WARRANTS THAT ALL DOCUMENTATION PROVIDED FOR ADMISSION TO THE PROGRAM IS TRUE, ACCURATE AND COMPLETE. IT IS GROUNDS FOR IMMEDIATE TERMINATION OF THIS AGREEMENT AND DISMISSAL FROM THE PROGRAM IF UTOLEDO DETERMINES THAT THE RESIDENT/FELLOW HAS SUBMITTED DOCUMENTATION WHICH CONTAINS MATERIAL MISREPRESENTATIONS OR OMISSIONS OF FACT. THIS AGREEMENT MAY BE DECLARED NULL AND VOID AND WILL NOT BECOME OR REMAIN EFFECTIVE IF: THE RESIDENT/FELLOW FAILS TO PROVIDE UTOLEDO WITH ALL DOCUMENTATION REQUIRED UNDER POLICY PRIOR TO THE COMMENCEMENT DATE; IF THE RESIDENT/FELLOW DID NOT PROVIDE COMPLETE OR ACCURATE DATA; OR, IF UTOLEDO DETERMINES THAT THE RESIDENT/FELLOWS DOCUMENTATION DOES NOT SUPPORT PARTICIPATION IN THE PROGRAM. Corrective Action or Termination. ý may take whatever corrective action against Resident/Fellow it believes is reasonable and appropriate under the circumstances to remediate disciplinary problems, academic or non-academic deficiencies, including but not limited to a written reprimand, extension of or additional training, probation, reassignment, temporary or permanent suspension, termination or non-reappointment. The exercise of ý's discretion in this regard will not be exercised arbitrarily or capriciously. All corrective action taken by ý against Resident/Fellow pursuant to this Section will comply with, follow and is subject to the Due Process procedures set forth in GME Policy 3364-86-008-00. Recommendations for corrective action for reasons other than academic deficiencies must be approved by the Associate Dean of Graduate Medical Education with final approval from the Dean of the College of Medicine and Life Sciences. Reasons for corrective action include, but are not limited to: loss of licensure or training certificate, falsification of credentials or other academic documents; professional misconduct; inability to perform the essential functions of the position with or without reasonable accommodation; unacceptable performance where there has been an intentional refusal, expressed or implied by conduct, to perform properly assigned academic duties; failure to hold in good standing a training certificate or licensure for the professional practice when the holding of such is a condition of appointment; and being charged with or convicted of a felony or crime of moral turpitude. Financial Support for Residents/Fellows. Resident/Fellow will receive the stipend specified below and to be paid at the "R" level ("Stipend"). ý will make appropriate deductions from the Stipend for such items as FICA, federal, state and city withholding taxes, as well as any state disability insurance premiums, PERS, or pension system. This will be the Resident/Fellows sole source of compensation under this Agreement. Resident/Fellow will not accept a fee of any kind for services to patients from any other source for the professional activity within the Program. Stipend: $XXXXXXXXXX per annum, payable bi-weekly Conditions for Reappointment and Promotion to a Subsequent PGY Level. Reappointment or promotion of Resident/Fellow to the next level of training is at the discretion of the Program Director and the Clinical Competency Committee (hereinafter CCC) and ultimately ý. When making a decision to reappoint or promote Resident/Fellow, the Program Director will consider many factors, including but not limited to, the following: satisfactory completion of all training components, satisfactory performance evaluations, past disciplinary record, collegiality, compliance by the Resident/Fellow with the terms of this Agreement, the continuation of ý Program accreditation by the Accrediting Body, the availability of a position for which the Resident/Fellow is qualified, ýs financial ability, furtherance of ýs objectives or any other relevant factor. In the event that the Program Director and the CCC determine not to reappoint the Resident/Fellow to the Program, or not to promote the Resident/Fellow to the next level of residency education, the Program Director will notify the ý Associate Dean of Graduate Medical Education of the intention of non-reappointment or non-promotion within a timely fashion in order provide the Resident/Fellow with one hundred twenty (120) days advance written notice of such election which will set forth the reasons for non-reappointment or non-promotion. However, should reasons supporting an election not to reappoint or not to promote a Resident/Fellow become apparent less than one hundred twenty (120) days prior to the Expiration Date of this Agreement, the Program Director may elect not to reappoint or not to promote the Resident/Fellow provided that the Resident/Fellow is given as much advance written notice of the election as circumstances will reasonably allow, prior to the Expiration Date this Agreement. Grievance and Due Process. When non-reappointment or non-promotion is based upon the Resident/Fellows performance, action or conduct, or upon the Resident/Fellows qualifications, credentials, licensure or professional standing, such non-reappointment or non-promotion, will be subject to the Due Process procedures set forth in GME Policy 3364-86-008-00. When non-reappointment of Resident/Fellow is based on ýs business decisions or considerations exclusively related to ý as an institution, or other reasons apart from the Resident/Fellows performance, action or conduct, qualifications, credentials, licensure or professional standing, such non-reappointment will be final and not subject to further appeal or review granted by ýs Due Process Procedures set forth in GME Policy 3364-86-008-00. In the event that the Program or Institution is closed, discontinued or reduced, all Resident/Fellows will be entitled to advance notification of the projected effective date; reasonable assistance in finding appointment to another residency program; payment of the Stipend and provision of benefits under this Agreement up to and including the Expiration Date, fiscal resources permitting; and proper care, custody and disposition of residency education records, and appropriate notification to licensure and specialty boards. Resident/Fellow acknowledges that under no circumstances will Resident/Fellow be entitled to the due process and appellate rights granted to physician members of the medical staff as described in a Participating Sites medical staff bylaws. Professional Liability Insurance, Including a Summary of Pertinent Information Regarding Coverage. ý will provide Resident/Fellow with professional liability insurance for Resident/Fellows acts or omissions that occur during Resident/Fellows participation in the Program and covered under the insurance policy. Moonlighting activities of Resident/Fellow are not covered. An overview of the coverage can be provided upon request. Health Insurance Benefits for Residents/Fellows and Their Eligible Dependents. Resident/Fellow and Resident/Fellows dependents will be offered insurance coverage and benefits as provided under ý policy. It is the Resident/Fellows obligation to select and enroll in the benefit programs. ý reserves the right to modify or discontinue any benefit offered to Resident/Fellow in conjunction with any modification or discontinuation of benefits. Disability Insurance for Residents/Fellows. Resident/Fellow and Resident/Fellows dependents will be provided coverage as provided by ý policy It is the Resident/Fellows obligation to select and enroll in the benefit programs. ý reserves the right to modify or discontinue any benefit offered to Resident/Fellow in conjunction with any modification or discontinuation of benefits. Vacation and Leave(s) of Absence for Residents/Fellows, Including Medical, Parental, and Caregiver Leave(s) of Absence, and Compliant with Applicable Laws. Resident/Fellow is entitled to leaves of absence for vacation, health, medical, and professional reasons according to the GME leave policies, compliant with applicable laws, and general ý employee benefit policies. Timely Notice of the Effect of Leave(s) of Absence on the Ability of Residents/Fellows to Satisfy Requirements for Program Completion. Resident/Fellow acknowledges that after any leave of absence, additional training may be required for successful completion of the Program or for Board Certification. The necessity of additional training will be determined by the Program Director. ýs policies regarding leaves of absence are applicable to Resident/Fellow. Information Related to Eligibility for Specialty Board Examinations. Resident/Fellow acknowledges that after any leave of absence, additional training may be required for successful completion of the Program or to meet eligibility requirements for board certification. Resident/Fellow agrees to consult applicable board regarding the boards eligibility requirements and consult with the Program Director regarding Resident/Fellow status in meeting those requirements. Institutional Policies and Procedures Regarding Resident/Fellow Clinical and Educational Work Hours and Moonlighting. Any work or professional activity by the Resident/Fellow outside the scope of this Agreement (Moonlighting) is strictly prohibited unless the conditions required under GME Policy 3364-86-018-00 are satisfied, as determined solely by ý. Resident/Fellow must provide a certificate of professional liability insurance and unrestricted license to the Program Director covering Moonlighting. Per Section 6 above, Moonlighting is not covered by ý professional liability insurance policy. Resident/Fellow will perform all obligations hereunder during such hours as the Program Director may direct in accordance with state and federal law, Accrediting Body requirements and GME Policy 3364-86-012-00 Duty Hours for Residents. Call schedules and schedule of assignments will be made available to and have been reviewed by Resident/Fellow prior to execution of this Agreement. Changes to these schedules will be distributed by the Program. Discrimination. ý of Toledo does not and will not discriminate in employment or educational programs on the basis of race, color, religion, sex, age, ancestry, national origin, sexual orientation, gender identity and expression, military or veteran status, disability, familial status, political affiliation, or participation in protected activity. Concerns that these commitments have been violated should be reported promptly as described under policies 3364-50-01, 02, or -03. Notification by Resident/Fellow. Resident/Fellow is obligated to notify the Associate Dean of Graduate Medical Education immediately upon the loss of state licensure or the training certificate, charge or conviction of any crime other than minor parking or moving violations, including but not limited to operating a vehicle under the influence, a crime of dishonesty or moral turpitude, or any professional misconduct and such failure to report may result in immediate suspension or termination. 409A. Notwithstanding anything to the contrary contained in this Agreement, the provisions of this Agreement are intended to comply with Internal Revenue Code Section 409A, any regulations promulgated thereunder, and administrative pronouncements interpreting Internal Revenue Code Section 409A and such regulations and will be interpreted and applied in a manner consistent with Internal Revenue Code Section 409A, such regulations, and such pronouncements. Notwithstanding any other provision of this Agreement, Resident/Fellow is responsible for payment of any additional taxes (including interest and penalties with respect thereto) imposed on them as a result of Code Section 409A. Miscellaneous Provisions. This Agreement constitutes the entire understanding of the Parties, and no alterations, modifications or additions to this Agreement will be binding upon the Parties unless in writing and signed by both of the Parties. This Agreement will not be assigned by either Party without the prior written consent of the other Party. This Agreement is intended for the exclusive benefit of Parties and their respective successors and assigns and nothing contained in this Agreement will be construed as creating any rights or benefits in or to any third party. This Agreement will be governed by the laws of the state of Ohio. The intention of the Parties is to comply fully with all laws, ý policies and public policies and this Agreement will be construed consistently with all laws and public policies to the extent possible. If, and to the extent that, any court of competent jurisdiction is unable to so construe part or all of any provision of this Agreement, and holds that part or all of that provision to be invalid, such invalidity will not affect the balance of that provision or the remaining provisions of this Agreement, which will remain in full force and effect. Waiver. No delay or failure to enforce any provision of this Agreement will constitute a waiver or limitation of rights enforceable under this Agreement. Signature page follows. IN WITNESS WHEREOF, the Parties have caused this Agreement to be executed on the dates set forth below. For The University of Toledo: _____________________________________________ Date:____________ Program Director ____________________________________________ Date:_____________ Associate Dean for GME ____________________________________________ Date:_____________ Human Resources Appointing Authority I understand and have read the policies governing Graduate Medical Education leave and benefits for Resident/Fellows and all other Graduate Medical Education policies, and all other applicable ý policies on ý website HYPERLINK "http://utoledo.edu/policies"http://utoledo.edu/policies. I understand these polices serve as the Graduate Medical Education Policy Handbook. I understand that I am bound by the policies contained on the website and all policies governed by ý and applicable Participating Sites polices at which I rotate. I understand that policies may be changed, revised, or added after the commencement of this Agreement. 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