DEPARTMENT OF VETERANS AFFAIRS

Greater Los Angeles Healthcare System AY 2019-2020 TRAINEE PROCESSING CHECKLIST

Missing or incomplete documents will delay your rotation to GLA VA Hospital.

Have you ever been badged? _____ Y ______N Do you have a VA badge? _____ Y ______N If yes, what is the expiration date? ________________ If you answered yes to the above questions and your badge is still valid (not expired), go to page 3 of this packet. CHECKLIST FOR ALL NEW TRAINEES, INCLUDING CONTINUING TRAINEES WITHOUT

VA BADGES

NOTE: Everything must be filled out completely prior to returning the packet to your training program coordinator for review and transmission to GLA. Please remember that the federal government is very strict about these forms; therefore, those that are not completed correctly and accurately will be returned. The original forms must be submitted to the VA. DO NOT submit incomplete packets. Below is a checklist and overview of the instructions for all the required documents and the processing for your VA rotation. Remember to answer everything to the best of your knowledge and use your full legal name. If something does not pertain to you, please enter “N/A”. Remember to print clearly and legibly as others will be working on your paperwork. If you make a mistake, cross it out and initial it. See page 4 for the VA onboarding process for new trainees and pages 11-14 for a list of VA Service Point of Contacts.

Application for Health Professions Trainees (VA Form 10-2850D): o Complete entire form (4 pages) & manually sign (electronic signatures are not accepted).

Declaration for Federal Employment (OF-306): o On item 1 (FULL NAME), provide full name (FIRST, FULL MIDDLE, LAST). If you don’t

have a middle name, indicate “No Middle Name”. If you only have an initial, indicate, “Initial Only”.

o For item 3A, please include city & state or country. For example, Seoul, South Korea, or Los Angeles, CA.

o Sign & date on line 17A ONLY. Fingerprint Record Prep Sheet:

o Under “FULL NAME”, provide Last, First, and Middle. You MUST have TWO IDs that match this. For example, if your IDs show your full middle name, you must write it out.

o Under “RACE”, please enter “American Indian or Alaskan Native”, “Asian or Pacific Islander”, “Black-non-Hispanic”, “Hispanic”, or “White-non-Hispanic”. You must select one race even if you are of mixed race.

o Do not sign the bottom of this form until you get your fingerprints completed. VSC Form #2:

o Complete entire form. o For item C, write “resident, fellow, or student.”

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o For item D, provide the name and location of the VA Facility where you’re getting fingerprinted. For West LA, write: GLA, 11301 Wilshire Blvd Los Angeles, CA 90073.

o For item E, provide the name of the VA PIV Office Official (your VA PIV Sponsor, see pages 11-14).

o Leave item H blank. Form I-9:

o Read instructions and complete Section 1. Section 2 will be completed and verified by the H/R Specialist during your “swear-in”.

Applicant’s Statement of Selective Service Registration Status (Applies ONLY to male applicants):

o Unless male trainees meet certain exemptions under the Selective Service law, they must be registered with the Selective Service System. Otherwise, they are ineligible for appointment by executive agencies of the Federal Government. Check one, sign, and date the form.

o If you are not sure if you are registered, you can verify on the Selective Service Registration site at https://www.sss.gov/Home/Verification. If you’ve never registered, you will need to provide a letter from the Selective Service System with your application packet and bring a copy with you to your fingerprinting appointment.

Clinical Trainee Registration Form, 10-0410: o Complete the entire form.

Random Drug Testing Notification and Acknowledgement Memorandum: o Read, sign, and date. o Please note: this is in compliance with the National Drug Free Workplace Program.

Health Care Personnel Influenza Vaccination Form: o Complete, sign, date and include copy of vaccination.

GLA Hepatitis B Vaccine Consent or Declination Form: o Select the option that best fits your history.

Mandatory Training for Trainees (MTT): o All trainees are required to complete the MTT course. If you have never registered on the

Talent Management System (TMS), you will need to self-enroll (see page 6 for additional instructions).

o This course is an annual requirement; therefore, continuing trainees must retake the Refresher course annually. The training course is available via the following web address:

www.tms.va.gov/SecureAuth35/

o If completed prior to the application deadline (April 30, 2019), include a copy with your VA Application packet. Otherwise, submit it to your Service Coordinator ASAP. You will not be able to be “badged” until the training is completed.

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CHECKLIST FOR NEW/CONTINUING TRAINEES WITH A VALID VA BADGE

For any questions, please email either Elizabeth Acosta (Elizabeth.Acosta2@va.gov) or Emerald Marquez-Aldanese (Emerald.Marquez-Aldanese@va.gov).

Clinical Trainee Registration From, 10-0410: o Complete the entire form.

Health Care Personnel Influenza Vaccination Form: o Complete, sign, date and include copy of vaccination.

Mandatory Training for Trainees (MTT): o All trainees are required to complete the MTT course. If you have never registered on the

Talent Management System (TMS), you will need to self-enroll (see page 6 for additional instructions).

o This course is an annual requirement; therefore, continuing trainees must retake the Refresher course annually. The training course is available via the following web address:

www.tms.va.gov/SecureAuth35/

NOTE: Trainees are to inform his/her VA PIV Sponsor at least 6 weeks prior to the badge expiring so it can be re-issued. Trainees must complete MTT Refresher prior to contacting their VA PIV Sponsor.

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Dear VA Health Professions Trainee, Welcome to the Department of Veterans Affairs and the Veterans Health Administration (VHA). To participate in training, interact with patients and gain access to our information systems you must complete an on-line mandatory training item using the VA Talent Management System (TMS) 2.0. The item is titled VHA Mandatory Training for Trainees. And, you will be happy to know, that your training transfers between VA’s. So as long as you complete the training every 364 days and remain “in good standing” there should be minimal interruptions as you proceed through your education. VA TMS 2.0 is on the internet and can be accessed using Internet Explorer, Firefox, Safari and Google Chrome. Give yourself some time because there is a 20-minute delay while your profile is created. After enrolling you will need to wait 20 minutes before you can log in and complete the training. First, you will need to Self-Enroll* in TMS 2.0 and to do so you need the following facility specific information:

• VA Facility: Greater Los Angeles • VA Location Code: GLA • VA Point of Contact First Name: Obtain this information from page 11-

14, unless already working with a VA POC. • VA Point of Contact Last Name: Obtain this information from page 11-

14, unless already working with a VA POC. • VA Point of Contact Email address: Obtain this information from page

11-14, unless already working with a VA POC. • VA Point of Contact Phone Number: Obtain this information from page

11-14, unless already working with a VA POC. • Printed Certificate Required? Yes

*If you already have a VA TMS account, contact your POC or call the VA Enterprise Service Desk (ESD) at 1-855-673-4357. Again, welcome to the VA and thank you for doing your part toward establishing VA as a 21st century organization built on providing the best care and service possible for our Veterans!

Sincerely,

Dr. Karen Sanders Deputy Chief Academic Affiliations Officer VA Office of Academic Affiliations

Veterans Health Administration

Office of Academic Affiliations

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1.1 Already Have a TMS Account? Contact the ESD at 1 (855) 673-4357

1.2 Step-by-Step Instructions for Managed Self Enrollment (New Users) 1. From a computer, launch a web browser and navigate to https://www.tms.va.gov/SecureAuth35/ 2. Click the [Create New User] button. 3. Select the radio button for Veterans Health Administration (VHA) Click the [Next] button. 4. Select the radio button for Health Professions Trainee (NOT WOC) Click the [Next] button. 5. Complete all required fields, indicated by asterisk* and any non-required fields if possible.

Note: The email address you enter here will be your Username to log into the system. My Account Information: • Create Password* • Re-enter Password* • Social Security Number* • Re-enter Social Security Number* • Date of Birth* • Legal First Name* • Legal Last Name* • Middle Name is optional, but extremely helpful • Your e-mail Address* (Enter a personal email address. Do not use a School email address.

This address will become your UserID. Also, one-time-passcodes and training notifications will be sent here.)

• Re-enter your e-mail address* • Phone Number (Enter your phone number. You will have the option to receive one-time-

passcode information at this phone number.) • Time Zone ID* My Job Information: • VA Location Code* (Filter and select the Code provided on Page 1 by your VA Point of

Contact) • Trainee Type* • Specialty/Discipline* • VA Point of Contact First Name* (Enter the name provided on page 1) • VA Point of Contact Last Name*(Enter the name provided on page 1) • VA Point of Contact Email*(Enter the email provided on page 1) • Point of Contact Phone Number* (Enter the phone number provided on page 1) • School/University* • School/University Start Date* • Estimated School/University Completion Date* Click the [SUBMIT] button when all required fields are completed.

6. You should now see the Congratulations! Screen. Take note of your Username/Email Address. WAIT 20 MINUTES

* Your SSN is used only as a unique identifier in the system to ensure users do not create multiple profiles. The SSN is stored in a Private Data Table that cannot be accessed anywhere via the VA TMS interface. It is securely transferred to a VA database table inside the VA firewall where it can be confirmed, if necessary, by appropriately vested system administrators and/or Help Desk staff.

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7. After 20 minutes, please return to https://www.tms.va.gov/SecureAuth35/ 8. On the TMS 2.0 Login Screen enter your Username/Email Address and click the [SUBMIT] button 9. An email will be sent to your Username/Email Address containing a one-time-passcode enter it

using your keyboard or the on-screen number pad and click the [SUBMIT] button. 10. During this first time log in you will be asked to select and answer two security questions. These

will be used to reset your TMS password. 11. Select questions, enter response, confirm response. 12. Click the [Save] button. 13. You have now completed your TMS User Profile.

1.3 Launching and Completing the Content 1. Log into TMS using Username and one-time Passcode. 2. Click on the Home dropdown and select Learning

3. Click on the Start Course button next to VHA Mandatory Training for Trainees Pop-Up blockers MUST BE TURNED OFF

4. Complete all of the item content following the on-screen instructions. 5. Exit the item as instructed to accurately record your effort. 6. To print a Certification of Completion, click on My History and View All.

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P a g e | 10 WHO needs an NPI: Any health care practitioner can obtain an NPI. For the VHA, it is crucial that “billable” practitioners and residents obtain NPIs. Residents and fellows need NPIs if they work shifts in an Emergency Room where they have privileges and provide billable services. Residents and fellows who write outpatient pharmacy prescriptions in their own names will need NPIs. This may include physician residents (residents in medicine, surgery, psychiatry, rehabilitation, pathology, dermatology, or other specialties/subspecialties), as well as residents in optometry, podiatry, dentistry, and pharmacy. WHAT is an NPI: An NPI is a 10-digit numeric identifier. It does not carry information about you, such as the State where you practice, your provider type, or your specialization. Your NPI will not change, even if your name, address, taxonomy, or other information changes. BENEFITS: An NPI is a simple a single unique identifier across ALL health plans, thus eliminating the current use of different numbers and numbering systems. NPIs travel with providers and will be valid for work at VHA or any other health care system. HOW DO YOU APPLY FOR AN NPI?

• Visit the National Plan and Provider Enumeration System (NPPES) at https://nppes.cms.hhs.gov/NPPES/Welcome.do.

• Click on “Create or Manage an Account”. • A popup notification will appear and you will be redirected to I&A to create a User ID and Password.

When you are done, return to NPPES to log in and apply for or view/modify an NPI. • Upon completion of the application, print the confirmation page for your records.

Resident Cheat Sheet-How to Apply for an NPI

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VA SERVICE POINT OF CONTACTS

Specialty/Program VA Contact Information

GERIATRIC MEDICINE

Janice Gillins Janice.Gillins@va.gov (818) 891-7711 ext. 36097

HOSPICE & PALLIATIVE CARE Dorjan Jones Dorjan.Jones@va.gov (310) 478-3711 ext. 41398

INTERNAL MEDICINE Cardiology (Advanced Heart Failure & Transplant, Cardiovascular Disease, Clinical Cardiac Electrophysiology, Interventional) Dermatology Emergency Medicine Endocrinology Family Medicine Hematology & Oncology Infectious Diseases Internal Medicine (UCLA & Cedars-Sinai)

Tirone Bender Tirone.Bender@va.gov (310) 478-3711 ext. 43403 Arleen Taylor OR Elizabeth Acosta Arleen.Taylor@va.gov; Elizabeth.Acosta2@va.gov (310 478-3711 ext. 53346; ext. 40809

Kerri Frasca Kerri.Frasca@va.gov (310) 268-3002 Terry Henderson Terry.Henderson@va.gov (310) 268-3125 Emerald Marquez-Aldanese Emerald.Marquez-Aldanese@va.gov (310) 268-3155 Kerri Frasca Kerri.Frasca@va.gov (310) 268-3002 Henry Reed OR Meilin Gibbens Henry.Reed@va.gov; Meilin.Gibbens@va.gov (310) 478-3711 ext. 48712; ext. 41541 Kerri Frasca Kerri.Frasca@va.gov (310) 268-3002

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Specialty/Program VA Contact Information

Internal Medicine (Kern Medical Center)

Internal Medicine (White Memorial) Medical Genetics

Nephrology Preventive Medicine Pulmonary Disease & Critical Care Medicine Rheumatology Sleep Medicine

Anne Seydel Anne.Seydel2@va.gov (661) 632-1826

Karen Idlebird Karen.Idlebird@va.gov (818) 891-7711 ext. 39447 Kerri Frasca Kerri.Frasca@va.gov (310) 268-3002

Henry Reed OR Meilin Gibbens Henry.Reed@va.gov; Meilin.Gibbens@va.gov (310) 478-3711 ext. 48712; ext. 41541

Kerri Frasca Kerri.Frasca@va.gov (310) 268-3002 Dorjan Jones Dorjan.Jones@va.gov (310) 478-3711 ext. 41398 Terry Henderson Terry.Henderson@va.gov (310) 268-3125 Dorjan Jones Dorjan.Jones@va.gov (310) 478-3711 ext. 41398

NEUROLOGY Clinical Neurophysiology Neurology Residency Neuromuscular Medicine Vascular Neurology

Tricia Davidson OR Hilda Puno Tricia.Davidson@va.gov; Hilda.Puno@va.gov (310) 478-3711 ext. 41408; (310) 268-3595

PSYCHIATRY Addiction Psychiatry Forensic Psychiatry Geriatric Psychiatry Psychiatry

Nathaniel McFarland III OR Marvin Ellis Nathaniel.McFarlandIII@va.gov; Marvin.Ellis@va.gov (310) 478-3711 ext. 40755; ext. 42781

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Specialty/Program VA Contact Information

RADIOLOGY

Alana Campbell Alana.Campbell@va.gov (310) 268-3591

RADIATION ONCOLOGY

Thomas Kim Thomas.Kim2@va.gov (310) 478-3711 ext. 40779

SURGERY Anesthesiology Critical Care (PGY2+)

ENT General Surgery Gastroenterology Hand Surgery Head & Neck (Otolaryngology) Neurosurgery OBGYN (Reproductive & Endocrinology & Infertility Fellowship) Ophthalmology

Suzanne Lozano Suzanne.Lozano@va.gov (310) 478-3711 ext. 44757

Suzanne Lozano Suzanne.Lozano@va.gov (310) 478-3711 ext. 44757 Suzanne Lozano Suzanne.Lozano@va.gov (310) 478-3711 ext. 44757 Suzanne Lozano Suzanne.Lozano@va.gov (310) 478-3711 ext. 44757 Suzanne Lozano Suzanne.Lozano@va.gov (310) 478-3711 ext. 44757 Suzanne Lozano Suzanne.Lozano@va.gov (310) 478-3711 ext. 44757 Suzanne Lozano Suzanne.Lozano@va.gov (310) 478-3711 ext. 44757 Christina Mooring Christina.Mooring@va.gov (310) 478-3711 ext. 53544 Suzanne Lozano Suzanne.Lozano@va.gov (310) 478-3711 ext. 44757

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Specialty/Program VA Contact Information

Orthopedic Pediatric Gastroenterology Plastic Surgery Thoracic Surgery Urology Vascular Surgery

Dwight John Dwight.John@va.gov (310) 478-3711 ext. 48157 Suzanne Lozano Suzanne.Lozano@va.gov (310) 478-3711 ext. 44757 Christina Mooring Christina.Mooring@va.gov (310) 478-3711 ext. 53544 Christina Mooring Christina.Mooring@va.gov (310) 478-3711 ext. 53544 Christina Mooring Christina.Mooring@va.gov (310) 478-3711 ext. 53544 Christina Mooring Christina.Mooring@va.gov (310) 478-3711 ext. 53544

Dental Delphia Matthews Delphia.Matthews@va.gov (310) 268-3776