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PIKEVILLE MEDICAL CENTER PHYSICIAN SHADOWING PROGRAM PHYSICIAN AGREEMENT

I, , supervising physician, agree to allow , Shadowing Program Participant, to shadow my practice of medicine where and when appropriate at Pikeville Medical Center during the timeframe approved by Pikeville Medical Center.

 

I agree to be in direct supervision of said Shadowing Program Participant at all times or will arrange for direct supervision by a physician colleague.

 

Physician Signature:

 

Date:

 

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