Physician Shadowing Application

- AUGUST 20, 2024
Colors of Courage 5K Brings Hope to Patients and the Community
Runners and walkers are lacing up their shoes for the ninth Colors of Courage 5K Run/Walk to raise money to support cancer patients of the Lawson Cancer Center at Pikeville Medical Center. The Colors of Courage 5K is one of the most popular running/walking events in downtown Pikeville and will be held on the morning
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- AUGUST 19, 2024
Lawson Cancer Center Providing Comprehensive Oncology Care
The Lawson Cancer Center (LCC) at Pikeville Medical Center (PMC) provides healing and comfort for individuals and families navigating the challenging journey of a cancer diagnosis and treatment. Patients at the LCC receive comprehensive care, personalized treatment and unwavering support from the entire oncology team, which embraces a multidisciplinary approach to cancer care. This group
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- JUNE 17, 2024
Men Face a 33% Higher Risk of Colon Cancer Than Women
When it comes to types of cancer diagnosed in men, colorectal or colon cancer closely follows skin and prostate cancer and is the third leading cause of cancer-related deaths. The death rate for colorectal cancer has dropped in recent years, attributed to an uptick in screenings and improvements in treatment methods. Patients who participate in
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- MARCH 11, 2024
March Is Colorectal Cancer Awareness Month
March is Colorectal Cancer Awareness Month, a time set aside to focus on the third most common cancer worldwide and the second leading cause of cancer-related deaths each year in the United States. Colorectal cancer is known in the medical community as the “silent killer” because of its lack of symptoms. Too often, colon cancer
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First Name:
Middle Name:
Last Name:
Are you 16 or older?	Yes No
Date of Birth:
Home #:
Cell #:
Email Address:
Present Address:
SSN:
Timeframe of shadowing request:
Emergency Contact:
Name:
Phone #:
I represent and warrant that I am not now nor have I ever been (i) listed by an agency or entity as excluded, debarred, suspended, or otherwise ineligible to participate in any federal, state, or private health care benefit program; (ii) listed as an excluded party by the U.S. Department of Health and Human Services or General Services Administration; (ii) been charged with, convicted of, pled guilty to, or entered a plea of non contendere (or any similar plea) with respect to any healthcare related offense; or (iv) been sanctioned for any form of healthcare fraud or abuse. I will notify Pikeville Medical Center immediately upon the commencement of any proceeding against me in which the outcome may be any of the above-described events. I further agree to execute any documentation necessary to comply with PMC’s vaccination policy, including any authorizations to release my protected health information or otherwise apply for an appropriate exemption. I agree that before I can be accepted as a physician shadow I must comply with PMC’s vaccination policy and failure to comply may lead to me not being accepted as a physician shadow or being dismissed as a physician shadow. I hereby attest that all of the foregoing information is true and correct. I authorize Pikeville Medical Center to obtain such background and personal reports as are deemed necessary to verify that the information I have supplied is true and accurate. A copy of this authorization is valid as the original.
Participant Signature:
Date:
If younger than 18 years of age, please have a Parent/Legal Guardian read and sign the following: I hereby attest that I am the Parent/Legal Guardian of the Applicant and that all of the foregoing information is true and correct. I authorize Pikeville Medical Center to obtain such background and personal reports regarding the Applicant as are deemed necessary to verify that the information I have supplied is true and accurate. A copy of this authorization is valid as the original.
Parent/Legal Guardian Signature:
Date:

Latest News and Events

Colors of Courage 5K Brings Hope to Patients and the Community

Lawson Cancer Center Providing Comprehensive Oncology Care

Men Face a 33% Higher Risk of Colon Cancer Than Women

March Is Colorectal Cancer Awareness Month