ࡱ> /1.]  bjbj .!b!b  t$w-! JD n0, "X "J "J$Gr\  "B ^: FMG (Foreign Medical Graduate) Certification Statement Graduate of foreign medical schools employed by universities cannot principally practice medicine. When there is any patient care activity involved with an appointment, a letter of certification must accompany the application. Additionally, the Deans letter of Appointment/Hire must stipulate that the primary activities are teaching and/or research, and that any patient care incidental to the primary activities will be under the direction of a physician fully licensed in the State of Ohio who is also a U.S. citizen or Permanent Resident. EXAMPLE The program in which Dr. _____________________________will participate is predominantly involved with observation, consulting, teaching or research. Any incidental patient contact involving Dr. ________________________ will be under the direct supervision of a physician who is a U. S. citizen or Permanent Resident and who is licensed to practice medicine in the state of Ohio. Dr. ___________________________ will not be given final responsibility for the diagnosis and treatment of patients. Any activities of Dr. ___________________________will conform fully to the state licensing requirements and regulations for medical and health care professions in Ohio. Any experience gained in this program will not be creditable towards any clinical requirements for medical specialty board certification. Required signatures (please type in names below signatures): Advisor _________________________________________________________  Department Director _______________________________________________ Chief of Staff _____________________________________________________ Dean, School of Medicine ___________________________________________ _________________________________ Date 67 - 2 ~    hhhwxhhCJaJhhCJaJ 78Z [ c d U V TUV & Fgdgd$a$gd gd,1h/ =!"#$% s2&6FVfv2(&6FVfv&6FVfv&6FVfv&6FVfv&6FVfv&6FVfv8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH DA D Default Paragraph FontRiR  Table Normal4 l4a (k (No List PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭Vc:E3v@P~Ds |w<    8@0(  B S  ?   ! " # $ % & ' ( ) #66}   '::   9 *urn:schemas-microsoft-com:office:smarttagsplace=*urn:schemas-microsoft-com:office:smarttags PlaceName=*urn:schemas-microsoft-com:office:smarttags PlaceType9 *urn:schemas-microsoft-com:office:smarttagsStateB *urn:schemas-microsoft-com:office:smarttagscountry-region    -2~   $VJ&h^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hH$         }`wx  @ p@UnknownG.[x Times New Roman5Symbol3. .Cx Arial?= .Cx Courier New;WingdingsACambria Math"hagag   !r43QHP)?2!xx 6FMG (Foreign Medical Graduate) Certification StatementController's OfficeJaclyn Celebrezze Oh+'0 , HT t  8FMG (Foreign Medical Graduate) Certification StatementController's Office Normal.dotmJaclyn Celebrezze2Microsoft Office Word@@TЀ@TЀ  ՜.+,0< hp   ǿմý  7FMG (Foreign Medical Graduate) Certification Statement Title  !"#$%'()*+,-0Root Entry F0c21Table "WordDocument.SummaryInformation(DocumentSummaryInformation8&CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q