Independent Rotation Pre-Departure Paperwork Checklist
All paperwork must be submitted to Andrea Sprockett (andrea.sprockett@stanford.edu) at
least 30 days prior to departure.
Name:
Academic Institution:
Current Year:
Intern
PGY-2
PGY-3
PGY-4
Other (list):
Today’s Date:
Rotation Site:
Dates of Travel:
Required forms:
Waiver Form
Liability Form
MEDEX Evacuation Insurance Plan
Travel Clinic Verification
Travel Itinerary
Take the online ethics course and submit a printed certificate of completion
(http://ethicsandglobalhealth.org/)
Register your travel with Stanford University
Register your travel with the US Department of State to receive travel updates and
information
GME Away Rotation Form (submitted to GME office 60 days prior to departure)