Program Letter of Agreement Generator

NOTE: Please complete the following information which will populate the form. After the form is complete, please print it, get the Program Director and away site preceptor's signatures and forward to GME for Dr. Girard and a Contracts signature.

Q1B:  Is there an Affiliation Agreement in Effect? (see list of sites below)

YES                NO

ADVENTIST HEALTH HOSPICE
ASANTE HEALTH SYSTEM DBA THREE RIVERS COMMUNITY HOSPITAL
BLUE MOUNTAIN HOSPITAL
CENTRAL CITY CONCERN
CLACKAMAS COUNTY PUBLIC HEALTH DIVISION
EAST PORTLAND PEDIATRIC CLINIC
HOOPER MEMORIAL DETOXIFICATION CENTER
KAISER FOUNDATION HOSPITALS, KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST AND NORTHWEST PERMANENTE
KERR YOUTH AND FAMILY CENTER
LINFIELD COLLEGE
LOWER UMPQUA HOSPITAL
MCKENZIE SURGERY CENTER, LP
MERLE WEST MEDICAL CENTER
MORRISON CENTER
MULTNOMAH COUNTY
OPEN DOOR CLINIC KLAMATH FALLS
OREGON PUBLIC HEALTH DIVISION
OREGON STATE HOSPITAL
OREGON YOUTH AUTHORITY/Maclaren
OUTSIDE IN
PLANNED PARENTHOOD
PORTLAND ADVENTIST MEDICAL CENTER
PORTLAND STATE UNIVERSITY HEALTH SERVICE
PROVIDENCE MEDICAL CENTER
PROVIDENCE SAINT VINCENT
REED COLLEGE
ROGUE VALLEY MEDICAL CENTER
Rosemont Residential TX Center
SAINT CHARLES MEDICAL CENTER
SALUD MEDICAL CENTER INCORPORATED
SALVATION ARMY WHITE SHIELD
SHRINERS'S HOSPITAL
SKY LAKES MEDICAL CENTER AKA MERLE WEST
SOUTHWEST WASHINGTON MEDICAL CENTER
SPRINGBROOK NORTHWEST
TERWILLIGER PLAZA CARE CENTER
TILLAMOOK EDUCATION SERVICES DISTRICT
TUALITY HEALTH CARE
VETERANS AFFAIRS MEDICAL CENTER
VIRGINIA GARCIA MEMORIAL HEALTH CENTER
WALLOWA MEMORIAL HOSPITAL
WILLIS, DAVID M.D.