Complete, signed, dated clinical fellow application. Note: The bottom half of the form entitled "Recommendation for Appointment to the Clinical Fellow Staff" must be completed by the appropriate department/section chief.
CSR declaration
DEA declaration
Immunization Documentation Form, including evidence of PPD within the past 12 months
Copy of curriculum vitae
Adult Moderate Sedation.* If you are seeking privileges in moderate sedation, please:
- View the video, Sedation and Analgesia for non-Anesthesiologists
- Take the Post-Test. You must pass the test to be eligible for privileges.
- Provide proof of airway management in the form of a BLS, ACLS, or PALS certificate that is less than four years old.
*not applicable for physician applicants trained in anesthesiology, emergency medicine or critical care medicine.
Medical Staff Education (Mandatory Training) Instructions: Please visit the Yale CME website. Under "Online Learning", choose "YNHH Medical Staff Education" from the dropdown and click submit. Check the box next to "YNHH Medical Staff Education Course", you will be prompted to login, select "ok". If you do not already have an account, you will be required to set one up to complete the training. Once logged in, you will need to add the course to your cart and finalize the purchase (Note: There is no fee and you will earn 1 CME credit. Click on the link to view your course and then view the presentation and take the quiz. Once you have completed and passed the quiz, please complete the evaluation, print your certificate, and submit with your application.