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Get Augusta University Student Affiliation Information Form For Non-Contract Students

BE SUBMITTED. Please notify the Director of Medical Affairs (312-1408) or the Medical Staff Office (312-1403) when you begin your affiliation with the hospital. Please be sure to attach a copy of your license (if applicable). Nametags should be worn while in the hospital. STUDENT AFFILIATION INFORMATION FORM FOR NON-CONTRACT STUDENTS Student s Name Sponsoring Physician(s).

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