Application for Visiting or Observing Physicians at UIHC

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POLICY FOR VISITING OR OBSERVING PHYSICIANS AT UIHC
DURATION:
 Maximum of one month per fiscal year
 Requests for clinical observation periods that exceed one month require a written explanation
ELIGIBLE OBSERVERS:
 MD equivalents from non-US are eligible but who do not have UI CCOM appointments
 Visiting professors who come to lecture and/or spend a day or two in the departments which are purely
academic are not eligible
 Medical students are not eligible under this policy (refer to OSAC policies)
 Departments found to violate this policy will be precluded from applying for visiting observers for one year
following the violation
REQUIREMENTS:
 Completed Form (Application for Visiting or Observing Physician at UIHC)
 All badges must be obtained from UIHC Human Resources and must clearly identify the observer as a
VISITOR
 Signed confidentiality agreement
 Patients must be informed of observer and have the right to refuse
 Supervising physician shall accompany the observer and solicit consent from each patient after informing
the patient of the observer’s background
 The supervising physician shall ensure that the observer remains within the scope of an observer
 No CCOM appointment required
 No Iowa license required
 No credential checks or background checks are required
DEFINITIONS
 Observation means observation only as defined by the Iowa Board of Medicine
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Iowa Board of Medicine Adopted and Filed
“Observer” means a person who is not enrolled in an Iowa medical school or osteopathic medical school, who observes care
to patients in Iowa for a defined period of time and for a noncredit experience, and who is supervised and accompanied by an
Iowa-licensed physician as defined in 9.2(3). An observer shall not provide or direct hands-on patient care, regardless of the
observer’s level of training or supervision. The supervising physician may authorize an observer to read a chart, observe a
patient interview or examination, or witness procedures, including surgery. An observer shall not chart; touch a patient as part
of an examination; conduct an interview; order, prescribe or administer medications; make decisions that affect patient care;
direct others in providing patient care; or conduct procedures, including surgery. Any of these activities requires licensure to
practice in Iowa. An unlicensed physician observer or a medical student observer may touch a patient to verify a physical
finding in the immediate presence of a physician but shall not conduct a more inclusive physical examination.
An unlicensed physician observer may:
a.
Participate in discussions regarding the care of individual patients, including offering suggestions about diagnosis or
treatment, as long as the unlicensed physician observer does not direct the care; and
b.
Elicit information from a patient as long as the unlicensed physician does not actually perform a physical examination
or otherwise touch the patient.
Supervision of an observer. An Iowa-licensed physician who supervises an observer shall accompany the observer and
solicit consent from each patient, where feasible, for the observation. The physician shall inform the patient of the
observer’s background, e.g., high school student considering a medical career, a medical graduate who is working on
licensure. The supervising physician shall ensure that the observer remains within the scope of an observer as defined
in rule 9.1(147,148).
VPMA approval 2-5-09, updated 5-28-13
APPLICATION FORM FOR VISITING OR OBSERVING PHYSICIANS AT UIHC
Name of Visitor/Observer:
Observer’s Home Address/Institution:
Specialty/Area of Interest:
CCOM Faculty Sponsor’s Name:
Sponsoring Department:
HR Representative Name (for Faculty) :
Phone:
Campus Address:
Visitation start date:
Visitation end date:
Prior visit dates at UIHC? If so, give start and
end dates:
From:
To:
If current visit is proposed for longer than one month, explain why this is necessary:
Description of activities during this observation period:
Percent effort of the visitor in the following areas:
Education:
Research:
Clinical observation:
Funding Source:
Corp
Fund
Org
Dept
Sub
Dept
ID
Grant Program
Inst
Acct
Org
Dept
Acct
Fund
Cost
Visitor badge will be obtained from UIHC Human Resources
Confidentiality agreement signed/dated and on file:
Yes
No
I agree to abide by the observer rules set forth by the Carver College of Medicine and the University of Iowa Hospitals and
Clinics, pursuant to the administrative rules adopted by the Iowa Board of Medicine:
______________________________________________
Signature of Visiting/Observing Physician
Date
______________________________________________
Signature of Sponsoring Physician
Campus Address
Phone
Date
Campus Address
Phone
Date
______________________________________________
Signature of Clinical Service Head
Approved:
____________________________
Associate Dean for Faculty Affairs, CCOM
Date
Associate Director/Legal Counsel, UIHC
Date
Submit this form via e-mail to lori-posey@uiowa.edu
The completed form must be received no later than 30 days prior to the observer’s proposed start date at UIHC
VPMA approval 2-5-09, updated 5-28-13
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