Swaddle Corp.

Form 3C.4Montefiore aesculapian Center & Montefiore Associate IPAs Confidential - lord Reference Evaluation TO: ________________________________________DATE:_____ September 8, 2009______ applicator: ____Gabriel J. Kaufman, MD__________ DEPARTMENT: ______________________ The higher up listed physician or allied health provider is curtly applying for clinical privileges at our facility and/or for membership in the Montefiore Associated IPAs. Please complete the form and return it directly covering to us via fax or mail at: Montefiore checkup Center/CMO 200 Corporate Drive, Yonkers, NY 10701 Phone:(914) 377-4690 Fax:(914) 377-4791 This military machine rating should be based on demonstrated operate aboutance compared to that of what is more or less expected of a practitioner at his/her level of training, experience and background. I. birth OF REFERENCE TO APPLICANT 1. Your titl e or position at the sentence of ceremonial: ______Pediatric Resident_________________ 2. Dates of observation: _07_/_01_/_05 to _06_/_30_/_07__ II. APPLICANT’S PROFESSIONAL KNOWLEDGE, SKILLS AND ATTITUDE 1. ar there any clinical areas, procedures, or patient rascality levels, which you would be concerned about allowing the applier to manage/ cause if she/he were in put on with you?

No X Yes ( If yes, enthral excuse: _________________________________________________ ____________________________________________________________ _________________ _____ 2. Have you ever observed or been ! advised of any physical, mental, health, drug, alcohol dependence or new(prenominal) problems which the applicant has that have or could potentially impair his/her might to practice medicine in a reasonably expert and unspoiled manner? No X Yes ( If yes, please explain: _________________________________________________ ____________________________________________________________...If you need to get a full essay, order it on our website: BestEssayCheap.com

If you want to get a full essay, visit our page: cheap essay