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.
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- Physician name
- Specialty
- Orthopedics
- Oncology
- General practice
- Psychiatry
- License number
- Personal statement
- Attach your résumé
- Email address
- Phone number
- 1. Name
- 1. Phone
- 2. Name
- 2. Phone
- 3. Name
- 3. Phone
Evaluator
- Evaluator
Background check
- Graduation
- 1
- 2
- 3
- 4
- Scientific knowledge
- 1
- 2
- 3
- 4
- Knowledge within the field of expertise
- 1
- 2
- 3
- 4
- General medical practice
- 1
- 2
- 3
- 4
- Years of experience within the field
- 1
- 2
- 3
- 4
- Reputation
- 1
- 2
- 3
- 4
- Scientific community acceptance
- 1
- 2
- 3
- 4
- Papers and other publications
- 1
- 2
- 3
- 4
- Interpretation of clinical studies
- 1
- 2
- 3
- 4
- Additional comments
- Highlights
- Deep scientific knowledge
- Relevance within the field of expertise
- Bibliographical references
- Background check approval
- Approved
- Not approved
- Reason for non-approval
Reference check
- Contacted references from the start form
- Reference #1
- Reference #2
- Reference #3
- Final review and comments
Final approval
- Rating
- 1
- 2
- 3
- 4
- 5
- The background check was:
- Positive
- Negative
Physician approved
- Documents Post Evento
Physician not approved
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