Clinical background review

Template

Research and evaluate physicians based on their background, resumes and academic prestige. Analyse and rate all information and, then contact their referrals before making a positive or negative decision.

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Template structure

See how this template is structured. As this is just an example, you can customize it.

Start form

  1. Physician name
  2. Specialty
    • Orthopedics
    • Oncology
    • General practice
    • Psychiatry
  3. License number
  4. Personal statement
  5. Attach your résumé
  6. Email address
  7. Phone number
  8. 1. Name
  9. 1. Phone
  10. 2. Name
  11. 2. Phone
  12. 3. Name
  13. 3. Phone

Evaluator

  2. Evaluator

Background check

  1. Graduation
    • 1
    • 2
    • 3
    • 4
  2. Scientific knowledge
    • 1
    • 2
    • 3
    • 4
  3. Knowledge within the field of expertise
    • 1
    • 2
    • 3
    • 4
  4. General medical practice
    • 1
    • 2
    • 3
    • 4
  5. Years of experience within the field
    • 1
    • 2
    • 3
    • 4
  6. Reputation
    • 1
    • 2
    • 3
    • 4
  7. Scientific community acceptance
    • 1
    • 2
    • 3
    • 4
  8. Papers and other publications
    • 1
    • 2
    • 3
    • 4
  9. Interpretation of clinical studies
    • 1
    • 2
    • 3
    • 4
  10. Additional comments
  11. Highlights
    • Deep scientific knowledge
    • Relevance within the field of expertise
    • Bibliographical references
  12. Background check approval
    • Approved
    • Not approved
  13. Reason for non-approval

Reference check

  1. Contacted references from the start form
    • Reference #1
    • Reference #2
    • Reference #3
  2. Final review and comments

Final approval

  1. Rating
    • 1
    • 2
    • 3
    • 4
    • 5
  2. The background check was:
    • Positive
    • Negative

Physician approved

  1. Documents Post Evento

Physician not approved

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