Physician Shadowing Application

- APRIL 9, 2021
Cheryl’s Breast Cancer Journey at PMC
Cancer is a word that strikes fear in most people and revives painful memories of loved ones who have battled the dreaded disease. According to the CDC, cancer has claimed over half a million lives each year for the past several years. However, with advancements in treatments and technology, the number of cancer deaths are
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- APRIL 9, 2021
Fighting Cancer Through a Team Approach at PMC
As advancements are made in cancer research, new types of cancer and additional treatment options are discovered. These things all contribute to the complexity of modern cancer care. In addition to the physicians dedicated to cancer care, cancer treatment, many times, involves general surgeons, plastic surgeons, radiologists and a host of other disciplines offered at
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- MARCH 12, 2021
Last Round of Free Low-Dose CT Scans Beginning Soon
When it comes to the number of residents of Eastern Kentucky who are diagnosed with cancer, the region is far above the national average. In fact, according to an article published in the Journal of the American Medical Association, Eastern Kentucky has six of the top 10 counties in the United States for cancer death
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- MARCH 12, 2021
PMC Using Advanced Screening Tool for Breast Cancer Detection
Breast cancer is the most common type of cancer in women, occurring in about one in eight women. Pikeville Medical Center (PMC) is now offering a new screening tool designed specifically for dense breast tissue which could help detect breast cancer sooner. PMC now offers the Invenia Automated Breast Ultrasound System (ABUS) 2.0, by GE.
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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

Cheryl’s Breast Cancer Journey at PMC

Fighting Cancer Through a Team Approach at PMC

Last Round of Free Low-Dose CT Scans Beginning Soon

PMC Using Advanced Screening Tool for Breast Cancer Detection

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