Program Letter of Agreement (PLA)
To:
From: Greater Lawrence Family Health Center (GLFHC), Dr. Joseph W. Gravel, Jr. and Debra Shank,
Program Assistant
Subject: Resident Assignment requiring Program Letter of Agreement (PLA)
Date: February 9, 2016
This memo serves as an Agreement between Greater Lawrence Family Health Center’s Lawrence Family
Medicine Residency, 34 Haverhill Street, Lawrence, MA 01841 and _____________, which is involved in
resident education for required assignments in the Elective study of _____________________
It is effective from
The following people are responsible for the residents’ education and supervision when at your office:
At the GLFHC / Lawrence Family Medicine Residency:
Joseph W. Gravel, Jr., MD, Program Director
At the
required assignment site:
______________________________________________
The above mentioned people are responsible for the education and supervision of _____________ while
he is rotating at ____________.
1.
The faculty at WNCCHS must provide appropriate supervision of the resident while participating
in patient care activities and maintain a learning environment conducive to educating the resident
in the ACGME competency areas.
2.
The faculty must evaluate resident performance in a timely manner following any two or more
sessions with the same resident, and document this evaluation at completion of the assignment
by completing a blue competency based evaluation card (provided by LFMR and/or the resident).
3.
The content of the educational experiences has been developed according to ACGME
Residency Program Requirements and include the following goals and objectives:
a) Experience rural underserved medicine.
b) Understand barriers to care in rural areas.
c) Gain clinical skills in HIV medicine and do focused readings on the topic.
In cooperation with Joseph W. Gravel, __________________ is responsible for the day-to-day activities
of the Resident to ensure that the above specified goals and objectives are met during the course of the
educational experiences at ______________________.
The duration(s) of the assignment(s) to the participating site is: __________________
During assignments to ___________________ the resident will be under the general direction of the
Sponsoring Institution’s Graduate Medical Education Committee’s and Program’s Policy and Procedure
Manual and Participating Site’s policies.
Blood-borne Pathogens): ______________ must provide HIV, HBV, and HCV testing for the source
patient in the event the resident is exposed to blood or bodily fluids. GLFHC will be responsible for
providing post exposure follow-up according to the GLFHC Blood-borne Pathogens Standard for the
resident.
The resident is covered for their medical actions during Elective experiences as evidenced by the
attached notice of Malpractice coverage.
__________________will/will not be claiming these resident days for their GME funding.
GLFHC: Joseph W. Gravel, MD
_______________________________
Program Director signature, Date
_____________________________________
_______________________________
Physician Contact signature, Date