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Training Applicants
Access forms to obtain authorization to function in the role of a medical student, resident, observer, or proctor.

Individuals wishing to obtain authorization to function in any of the roles listed below must comply with all requirements prior to rotation/visit to our facilities.  The specific requirements for each role are listed below, as well as the links to specific documents.  Complete the appropriate form and return them to the Medical Staff Office.  You must allow at least two weeks and obtain approval prior to rotation or visit.  Authorization will not be granted until all requirements are met.  For contact information, please refer to the applicable section below. 

Medical Students

Please note:  Students currently enrolled in undergraduate programs or pre-med programs will need to contact Miranda Ingram, Director of Student Programs at 704-384-3275.

This section is applicable only to students currently enrolled in Medical Degree programs.  Individuals wishing to complete a student rotation at any Presbyterian facility, must obtain a sponsoring medical staff member, complete the required documents, and comply with all requirements specified in those documents.  Students are responsible for ensuring all requirements are met, and authorization must be granted by the Medical Staff Office prior to the student beginning the rotation.  Applicants will be notified of approval by the Medical Staff Office within two weeks following submission of all documentation.  An identification badge (required) will be provided only after authorization has been granted. 

  • Clinical Education Agreement must be in place with student’s current school.  
  • Letter from sponsoring member of the medical staff stating they agree to the rotation and dates of the rotation
  • Student Information Form
  • Self-Study Orientation Packet
  • Immunization Records for Hep B 
  • Current TB test within the current calendar year
  • Current Malpractice Insurance Certificate
  • Digital photo

Please contact Nakia Jackson at (704) 384-5786 or email nsellars@novanthealth.org if you have any questions.  Forms may be faxed to (704) 316-9574 or (704) 384-5838.

Residents

Presbyterian does not have formal training programs but residents may obtain authorization to complete a rotation with a physician member of the medical staff.  All requirements must be met prior to beginning the rotation.   Applicants will be notified of approval by the Medical Staff Office within two weeks following submission of all documentation.  An identification badge (required) will be provided only after authorization has been granted. 

  • Clinical Education Agreement must be in place with resident’s school.  If a current Clinical Education Agreement is not in place between Presbyterian and the school, then an agreement must be obtained prior to the resident’s rotation. 
  • Letter from sponsoring member of the medical staff stating they agree to the rotation and dates of the rotation
  • Copies of any license and/or training license
  • Current Curriculum Vitae
  • Current Malpractice Insurance Certificate
  • Resident Student Information Form
  • Orientation Self-Study Packet
  • Digital photo
  • Immunization Records for Hep B 
  • Current TB test within the current calendar year

Please contact Nakia Jackson at (704) 384-5786 or email nsellars@novanthealth.org if you have any questions.  Forms may be faxed to (704) 316-9574 or (704) 384-5838.

Observers

Individuals who wish to obtain authorization as an observer must obtain sponsorship by a member of the medical staff, and submit all required documentation prior to the observation experience.   Applicants will be notified of approval by the Medical Staff Office within two weeks following submission of all documentation.  An identification badge (required) will be provided only after authorization has been granted. 

Please contact Nakia Jackson at (704) 384-5786 or email nsellars@novanthealth.org if you have any questions.  Forms may be faxed to (704) 316-9574 or (704) 384-5838.

Proctors                    

Licensed physicians may serve as a proctor after submission of the required items noted below.  Applicants will be notified of approval as proctors by the Medical Staff Office within two weeks following submission of all documentation.  An identification badge (required) will be provided only after authorization has been granted.  These privileges are time-limited for 30 days and intended for educational purposes only.   

  • Non-Applicant Request for Privileges application
  • Letter from Chairman or Chief of Staff at current facility stating you are in good standing and competent to perform the privilege(s) requested
  • Current state license
  • Current Malpractice Insurance with limits of $1M/$3M
  • Current Curriculum Vitae
  • Evidence of Board Certification
  • ECFMG certificate (if applicable)
  • Self-Study Orientation Packet  (Complete pages 41-52)
  • Immunization Records for Hep B 
  • Current TB test within the current calendar year
  • Digital photo 

Please contact Margaret Hiraoka at (704) 384-5646 or email mkhiraoka@novanthealth.org if you have any questions.  Forms may be faxed to (704) 417-4277 or (704) 384-5838.