Get Moonlighting Policy

Filling out the Moonlighting Policy is an essential process for residents and clinical fellows wishing to engage in moonlighting activities. This guide provides clear instructions on how to effectively complete the Moonlighting Request Form to ensure compliance with the policy requirements.

Follow the steps to complete the Moonlighting Request Form online.

1. Click ‘Get Form’ button to access the Moonlighting Request Form and open it in your preferred editor.
2. Begin by entering your name and indicating whether you are a resident or clinical fellow, circling your appropriate title.
3. If applicable, provide your visa status. Then, fill in the name of your Training Program Director.
4. Specify the name of your ACGME or ABMS specialty or subspecialty program in the designated field.
5. Describe the moonlighting activity you are considering in detail. This should include the nature and responsibilities of the activity.
6. Indicate the location where you wish to perform these moonlighting activities.
7. Outline your proposed moonlighting schedule, making sure to include the days and hours you expect to work.
8. Document your residency or rotation schedule, including the actual hours worked over the past 30 days.
9. Select whether you intend to bill payors for your moonlighting services, ensuring you understand the relevant billing policy.
10. Acknowledge understanding of the total number of hours you may engage in internal moonlighting activities and that this must be approved by your Training Program Director.
11. Complete all other required understanding statements related to the nature of your moonlighting, including obtaining appropriate licensure and credentials.
12. Have the chairman/division chief/medical director of the department where you wish to moonlight sign the form for approval.
13. Sign and date the form, confirming all information is accurate and that you understand the responsibilities associated with moonlighting.
14. Submit the completed form to your Training Program Director and the Associate Dean for Graduate Medical Education for final approval.
15. Once approved, ensure that you save changes to the document. You may also download, print, or share the form as needed.

Complete your Moonlighting Request Form online today to ensure a smooth approval process.