Va Form 10-0094a - Medical Education Affiliation Agreement Between Department Of Veterans Affairs (Va), And A School Of Medicine And Its Affiliated Participating Institutions

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MEDICAL EDUCATION AFFILIATION AGREEMENT
BETWEEN DEPARTMENT OF VETERANS AFFAIRS (VA),
AND A SCHOOL OF MEDICINE
AND ITS AFFILIATED PARTICIPATING INSTITUTIONS
Use when trainees are enrolled in an academic program accredited by the Liaison Committee for
Medical Education (LCME) or the Accreditation Council for Graduate Medical Education (ACGME)
4
VA NETWORK
4
VA MEDICAL CARE FACILITY (including city and state)
4
SCHOOL OF MEDICINE (including city and state)
4
AFFILIATED PARTICIPATING INSTITUTION #1 (including ACGME ID number, city, and state)
4
AFFILIATED PARTICIPATING INSTITUTION #2 (including ACGME ID number, city, and state)
4
AFFILIATED PARTICIPATING INSTITUTION #3 (including ACGME ID number, city, and state)
4
AFFILIATED PARTICIPATING INSTITUTION #4 (including ACGME ID number, city, and state)
This agreement, when duly executed and approved by the Department of Veterans Affairs (VA), establishes
an affiliation between VA, its Veterans Integrated Service Networks, and the listed VA facilities, and the school
of medicine and its affiliated participating institutions for the academic purposes of enhanced patient care,
education, and research. A medical school and its affiliated institutions that are signatories to this document are
collectively referred to as “partner institutions.” All parties to the agreement have a shared responsibility for the
academic enterprise. The partner institutions accept primary responsibility for the integrated education programs
conducted with VA while VA retains full responsibility for the care of VA patients and administration of its
operation. Additional responsibilities are delineated below.
BACKGROUND
The provision of education for future health care providers and the conduct of research are VA statutory
missions. By virtue of the close relationships between VA and the nation’s academic institutions, VA plays a
VA FORM 10-0094a
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