Sample Advanced Pte Board Certification Letter Template printable pdf download

– SAMPLE LETTER –

Advanced PTE Board Certification

For Physicians who completed 12 month clinical fellowship dedicated to the

perioperative care of surgical patients with cardiovascular disease

(Requirements 4 and 5)

Date

National Board of Echocardiography, Inc.

1500 Sunday Drive, Suite 102

Raleigh, NC 27607

Physician’s Full Name

RE:

Physician’s Date of Birth

Physician’s Social Security Number (last 4 digits)

ACGME Program Number

To Whom It May Concern:

REQUIREMENT 4

This letter further confirms that Dr. ____(name)_____ successfully completed a minimum of 12 months of clinical fellowship training

dedicated to the perioperative care of surgical patients with cardiovascular disease at our institution between ___(beginning date)___

and ___(ending date)____. This letter further confirms that fellowship training was obtained at an institution with an affiliation with

an accredited core residency program.

REQUIREMENT 5

Our records indicate that __(he/she)__ had specific training in Perioperative Transesophageal Echocardiography and personally

performed, interpreted, and reported ___(#)____ comprehensive intraoperative TEE examinations under appropriate supervision. In

addition, ___(he/she)___ studied under appropriate supervision, but did not perform ____(#)___ studies for a total of ___(#)____

complete intraoperative TEE examinations. These studies include a wide spectrum of cardiac diagnoses.

I certify that the number of studies provided above are exact numbers and are not rounded and/or estimates.

Sincerely,

(signature)

Name

Notary Seal

Title (Residency Program Director, Fellowship Training Director, etc.)

Sworn and subscribed to before me on (date): ___________________________

_______________________________________________________________

Signature of Notary Public

NOTE: *The EXACT number of studies performed and interpreted MUST be provided. Applications containing

approximated and/or rounded numbers will no longer be reviewed by the Certification Committee. Letters MUST be on

appropriate letterhead and MUST be notarized

Sample Advanced Pte Board Certification Letter Template