- Name
- Social Security Number
- Individual National Provider ID (NPI) -- not Organization
- Date of birth
- Medical school
- Medical school completion date
- Start and expected completion dates
- Email address (program)
- Email address (personal)
- Race/Ethnicity
- Gender
- Did this resident/fellow have prior training? If so, how many years and what specialty?
- Did this resident/fellow start the program in year 1?
- Did you obtain documentation of previous educational experience?
Please note: some specialties have one or more specialty-specific questions that may be required and/or additional questions may be asked based on previous answers.
Residents/Fellows already in the database: If a match has been found in the database for a Resident/Fellow you are adding, you will be asked to confirm the previous training and some of the information will be pre-populated. Please review the information carefully.