Louisiana state university health science center new orleans emergency medicine residency program policies to supplement lsuhsc house officer manual

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HOUSE STAFF CLEARANCE FORM

WELLNESS CENTER

The Wellness Center is dedicated to promoting the health and well being of all members of the LSU Health Sciences Center community in a safe and educational environment.

Hours of Operation
Mon.-Fri.	6:30 am - 8:00 pm
Sat.	9:00 am - 1:00 pm
Sun.	Closed

Amenities 18,000 square feet Cardiovascular equipment: treadmills, bikes (upright and recumbent), ellipticals, rowers, and stair climbers Selectorized weight equipment: Nautilus Nitro Plate loaded/free weights A multipurpose room for group exercise activities, such as group cycling, mind body (yoga/pilates mat), step, resistance training, etc. Lounge area / Wireless Internet Spacious locker rooms with shower facilities

Contact Information
450 S. Claiborne Avenue
New Orleans, LA 70112
Phone: (504) 568-3700
Fax: (504) 568-3720
Email: wellness

Entry granted with a valid LSUHSC or MCLNO I.D.

Membership Requirements

All individuals must show a valid LSUHSC I.D. on the 3rd floor of Stanislaus Hall for entrance into the Wellness Center. In addition, initially, each individual member must complete an Express Assumption of Risk Release of Liability Form and a PAR-Q.

Forms

Express Assumption of Risk Release of Liability Form PAR Q
Free Admission is granted to:

LSUHSC Students, Residents, Faculty, and Staff
Spouses and Children 16 years or older of LSUHSC Students, Residents, Faculty, and Staff
*MCLNO Staff ONLY
*HCSD Staff ONLY

HOUSE STAFF CLEARANCE FORM

Each resident completing final rotations (prior to graduation) must have this form processed before a final certificate will be issued. Signatures indicate that your medical records are complete; you have returned lab coats; and you have returned Autovalet Cards.

NAME OF RESIDENT
SCHOOL/DEPARTMENT	DATE OF DEPARTURE

	Signature	Date
MEDICAL RECORD SERVICES Doctor’s Dictation area All records dictated and signed up to including departure date and reassignment form completed.
COAT EXCHANGE
AUTOVALET CARDS
RESIDENCY PROGRAM DIRECTOR

Completed form should be submitted to the Medical Staff Office

MEDICAL CENTER OF LOUISIANA AT NEW ORLEANS

MEDICAL RECORD SERVICES

CERTIFICATE REQUEST

Certificates are awarded only when you have completed entire program –internship, residency and fellowship, if applicable. This form must be approved by your Residency Program Director.
Please complete, as you want your certificate to read.

Name:________________________________________________________________________

First Middle Last Degree

Status: (circle one) Intern Resident Fellow
School: (circle one) LSU or TULANE
Department:____________________________________________
Dates:_______________________to_________________________

If any year was in a different program, please provide that information.
Status: (circle one) Intern Resident Fellow
School: (circle one) LSU or TULANE
Department:____________________________________________

Dates:________________________to________________________

Permanent forwarding address for mailing certificate:
________________________________________________________________ ________________________________________________________________

_______________________________________________________________

________________________________________________________________

APPROVAL:
I have reviewed applicant’s request for MCL certificate and verify that information provided above is accurate.
_____________________________________________________________________

Residency Program Director Date
CERTIFICATE REQUESTS THAT HAVE NOT BEEN APPROVED BY RESIDENCY PROGRAM DIRECTOR WILL NOT BE PROCESSED.

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