<p> Baylor College of Medicine Graduate Medical Education PROGRAM LETTER OF AGREEMENT </p><p>University Name and Program: Baylor College of Medicine Training Site: Department/Specialty: This Program Letter of Agreement (“PLA”) between Baylor College of Medicine (“BCM”) and (“University”), effective , 20 (“Effective Date”), defines specific educational components to comply with the Accreditation Council for Graduate Medical Education (“ACGME”) policies and procedures for graduate medical education. This PLA does not take precedence over the master affiliation agreement, if any, between BCM and University. The University Program Director, , shall maintain responsibility for the quality of the education under this PLA.</p><p>1. is the Site Director at the Training Site who agrees to administrative, educational, and supervisory responsibilities for the Resident(s) during the rotation at the Training Site, including responsibility for teaching, supervision, and formal evaluation of the resident’s performance during the rotations.</p><p>2. The educational purpose, as well as goals and objections, of this Rotation are outlined in Attachment A, “Goals and Objectives.” The goals and objectives are to provide a superior learning and training experience in a supervised educational setting.</p><p>With the cooperation of University, Training Site will be responsible for the day to day activities of the Resident(s) to ensure that the outlined goals and objectives are met for the Resident(s) during their Rotation at Training Site. </p><p>3. Residents will participate in rotations as defined in the University course catalogue and scheduled by the University Program Director. Prior notice, when possible, will be made for any changes in these Rotations. The maximum number of residents who will be rotating at any one time is .</p><p>4. Resident(s) will be under the general direction of the policies of University as well as the relevant policies, procedures, and medical staff bylaws applicable to Training Site. This training will be in compliance with all current ACGME requirements.</p><p>5. The faculty at Training Site must provide appropriate supervision of resident patient care activities as specified in the ACGME program requirements. In addition, they must maintain a learning environment conducive to educating the residents in the ACGME competency areas. The faculty must evaluate Resident performance in a timely manner during each rotation or similar educational assignment and document this evaluation at completion of the assignment.</p><p>Term and Termination</p><p>A. This PLA will be effective for a term of Choose an item., commencing on the Effective Date, or until updated, changed or terminated by either Party. </p><p>B. This PLA may be terminated by either party upon written notice to other party 150 days prior to termination, provided that any Residents currently participating in the Rotation at the time of notice be permitted to complete their Rotation under the Program.</p><p>(Signature Page Follows) Executed in one or more counterparts, each of which will be deemed an original, but all of which together will constitute one and the same instrument. </p><p>Baylor College of Medicine: University:</p><p>By:______By:______Linda Andrews, MD Name: Senior Associate Dean & DIO Title: _Program Director_____ Graduate Medical Education</p><p>By:______Name: Title:_Site Director______</p><p>Acknowledged: Acknowledged:</p><p>By: ______By: ______Name: Name: Title: Title: Date: Date: </p><p>BCM Address: University Address: Baylor College of Medicine Graduate Medical Education One Baylor Plaza, BCM220 Houston, TX 77030 Attn: Linda Andrews, MD Exhibit A</p><p>BASIC INFORMATION:</p><p>Rotation: Site Director: Program Director: Normal Hours: Call: Didactics: Continuity Clinic:</p><p>GOALS & OBJECTIVES:</p>