The University of Mississippi Medical Center (UMMC) offers twelve-month postgraduate year one (PGY1) pharmacy practice and postgraduate year two (PGY2) critical care and PGY2 infectious disease residencies, all accredited by the American Society of Health-System Pharmacists (ASHP). All residencies run from July 1 through June 30 of the following year. Residents are full-time professional staff members in an academic curriculum of the Department of Pharmacy Services who report directly to their Residency Program Director (RPD) and the Director of Pharmacy Services. Upon successful completion of all program requirements, residents are awarded a residency certificate indicating they have achieved the competency areas, goals, and objectives of their respective residency program.

This manual will serve to guide the resident by providing a general overview of various aspects of the residency
programs.

PGY1 Pharmacy Residency Program

The PGY1 Residency centers on development of the knowledge, skills, attitudes, and abilities gained from an accredited professional pharmacy degree program. The residency program enhances general competencies in managing medication use systems and supports optimal medication therapy outcomes for patients with a broad range of disease states.

Purpose

PGY1 pharmacy residency programs build on Doctor of Pharmacy (Pharm.D.) education and outcomes to develop pharmacist practitioners with knowledge, skills, and abilitiesas defined in the educational competency areas, goals, and objectives. Residents who successfully complete PGY1 residency programs will be skilled in diverse patient care, practice management, leadership, and education, and be prepared to provide patient care, seek board certification in pharmacotherapy (i.e., BCPS), and pursue advanced education and training opportunities including postgraduate year two (PGY2) residencies.

Structure

In order to achieve the desired goals of the PGY1 Pharmacy Residency Program, learning experiences have been developed to facilitate achievement of the ASHP required competency areas, goals, and objectives.

Required Rotations

Monthly

Longitudinal Activities

Orientation
Adult Medicine
(1) Critical Care Experience#
(1) Pediatric Experience#

(1) Infectious Diseases Experience#

Research

Research Project
Practice Management
Staffing (Central & Critical Care Pharmacy)
Anticoagulation Clinic
Medication Use Evaluation and P&T Project
Hospital Committee Experience
Medical Emergency Response

# Choose from elective rotation options below

Elective Monthly Rotations

Adult Medicine II	Critical Care - Surgical ICU
Adult Cardiology	Critical Care - Medical ICU
Adult Neurology	Critical Care - Cardiovascular ICU
Adult Oncology	Critical Care - Neuroscience ICU
Nephrology/Transplant - Inpatient	Adult Emergency Department
Nutrition Support	Infectious Diseases - Antimicrobial Stewardship
General Pediatrics	Infectious Diseases - Adult ID Consults
General Pediatrics II	Administration/Management
Pediatric Inpatient Hematology/Oncology	Specialty Pharmacy
Pediatric ICU	Cystic Fibrosis Clinic
Neonatal ICU	Heart Failure Clinic
Pediatric Emergency Department	Medicine/Pediatrics Clinic
Academia

Required Competency Areas, Goals, and Objectives

Competency Area R1 Patient Care
Goal R1.1	In collaboration with the health care team, provide safe and effective patient care to a diverse range of patients, including those with multiple co-morbidities, high-risk medication regimens, and multiple medications following a consistent patient care process
Objective R1.1.1	Interact effectively with health care teams to manage patients' medication therapy
Objective R1.1.2	Interact effectively with patients, family members, and caregivers
Objective R1.1.3	Collect information on which to base safe and effective medication therapy
Objective R1.1.4	Analyze and assess information on which to base safe and effective medication therapy
Objective R1.1.5	Design or redesign safe and effective patient-centered therapeutic regimens and monitoring plans (care plans)
Objective R1.1.6	Ensure implementation of therapeutic regimens and monitoring plans (care plans) by taking appropriate follow-up actions
Objective R1.1.7	Document direct patient care activities appropriately in the medical record or where appropriate
Objective R1.1.8	Demonstrate responsibility to patients
Goal R1.2	Ensure continuity of care during patient transitions between care settings
Objective R1.2.1	Manage transitions of care effectively
Goal R1.3	Prepare, dispense, and manage medications to support safe and effective drug therapy for patients
Objective R1.3.1	Prepare and dispense medications following best practices and the organization's policies and procedures
Objective R1.3.2	Manage aspects of the medication-use process related to formulary management
Objective R1.3.3	Manage aspects of the medication-use process related to oversight of dispensing
Competency Area R2 Advancing Practice and Improving Patient Care
Goal R2.1	Demonstrate ability to manage formulary and medication-use processes, as applicable to the organization
Objective R2.1.1	Prepare a drug class review, monograph, treatment guideline, or protocol
Objective R2.1.2	Participate in a medication-use evaluation
Objective R2.1.3	Identify opportunities for improvement of the medication-use system
Objective R2.1.4	Participate in medication event reporting and monitoring
Goal R2.2	Demonstrate ability to evaluate and investigate practice, review data, and assimilate scientific evidence to improve patient care and/or the medication-use system
Objective R2.2.1	Identify changes needed to improve patient care and/or the medication-use system
Objective R2.2.2	Develop a plan to improve the patient care and/or the medication-use system
Objective R2.2.3	Implement changes to improve patient care and/or the medication-use system
Objective R2.2.4	Assess changes made to improve patient care or the medication-use system
Objective R2.2.5	Effectively develop and present, orally and in writing, a final project report
Competency Area R3 Leadership and Management
Goal R3.1	Demonstrate leadership skills
Objective R3.1.1	Demonstrate personal, interpersonal, and teamwork skills critical for effective leadership
Objective R3.1.2	Apply a process of on-going self-evaluation and personal performance improvement
Goal R3.2	Demonstrate management skills
Objective R3.2.1	Explain factors that influence departmental planning
Objective R3.2.2	Explain the elements of the pharmacy enterprise and their relationship to the health care system
Objective R3.2.3	Contribute to departmental management
Objective R3.2.4	Manages one's own practice effectively
Competency Area R4 Teaching, Education, and Dissemination of Knowledge
Goal R4.1	Provide effective medication and practice-related education to patients, caregivers, health care professionals, students, and the public (individuals and groups)
Objective R4.1.1	Design effective educational activities
Objective R4.1.2	Use effective presentation and teaching skills to deliver education
Objective R4.1.3	Use effective written communication to disseminate knowledge
Objective R4.1.4	Appropriately assess effectiveness of education
Goal R4.2	Effectively employs appropriate preceptor roles when engaged in teaching students, pharmacy technicians or fellow health care professionals
Objective R4.2.1	When engaged in teaching, select a preceptor role that meets learners' educational needs
Objective R4.2.2	Effectively employ preceptor roles, as appropriate
PGY1 Elective - Pharmacy Research (2014)
Competency Area E1 Pharmacy Research
Goal E1.1	Conduct and analyze results of pharmacy research
Objective E1.1.1	Design, execute, and report results of investigations of pharmacy-related issues
Objective E1.1.2	Participate in prospective and retrospective clinical, humanistic, and economic outcomes analysis

Requirements for Graduation:

In addition to the requirements listed in "Requirements for Graduation," residents must also complete all projects and requirements as listed on the "Annual PGY-1 Residency Requirements" checklist.

Updated 6/2023

PGY2 Pharmacy Residency Programs

PGY2 pharmacy residency programs build on Doctor of Pharmacy (Pharm.D.) education and PGY1 pharmacy residency programs to contribute to the development of clinical pharmacists in specialized areas of practice. PGY2 residencies provide residents with opportunities to function independently as practitioners by conceptualizing and integrating accumulated experience and knowledge and incorporating both into the provision of patient care or other advanced practice settings. Residents who successfully complete an accredited PGY2 pharmacy residency are prepared for advanced patient care, academic, or other specialized positions, along with board certification, if available.

PGY2 Critical Care Program

Purpose

In addition to ASHP purpose of PGY2 residency programs, the PGY2 Critical Care Pharmacy Residency Program at University of Mississippi Medical Center exists to achieve three main overarching goals.

To develop confident and competent critical care practitioners.
To develop well-rounded educators effective in teaching current health care professionals and health care professionals in training.
To promote a desire for pursuit and participation in critical care clinical research.

Structure

In order to achieve the desired goals noted above, learning experiences have been designed to facilitate achievement of ASHP required competency areas, goals, and objectives. Names of preceptors for each rotation are provided in the preceptor roster and learning experience descriptions.

Required Rotations		Elective Rotations
Monthly	Longitudinal	Monthly
Orientation	Longitudinal Resident Progression	Antimicrobial Stewardship
Medical ICU	Critical Care Management	Cardiovascular ICU
Adult Emergency Department	Research	ICU/ED Second Shift Coverage
NeuroScience ICU	Staffing	ICU Pharmacy Management
Surgical ICU	Teaching and Preceptorship	Pediatric ICU
Nutrition Support		Medical ICU II
Research		ICU/ED Midnight Coverage
		Intensive Care Unit Float

ASHP competency areas, goals and objectives are selected for the PGY2 Critical Care Residency Program to meet the program's purpose. Residents are required to familiarize themselves with objectives associated with each goal.
Objectives are intended to be matched with specific activities outlined in each learning experience. Achievement of all objectives for a specified goal will signify achievement of the associated goal and achievement of all goals for a specified outcome will signify achievement of the associated competency area.

Required Competency Areas, Goals, and Objectives

Competency Area R1: Patient Care
Goal R1.1	In collaboration with the healthcare team, provide comprehensive medication management to critically ill patients following a consistent patient care process.
Objective R1.1.1	(Applying) Interact effectively with health care teams to manage critically ill patients' medication therapy.
Objective R1.1.2	(Applying) Interact effectively with critically ill patients, family members, and caregivers.
Objective R1.1.3	(Analyzing) Collect information on which to base safe and effective medication therapy for critically ill patients.
Objective R1.1.4	(Analyzing) Analyze and assess information on which to base safe and effective medication therapy for critically ill patients.
Objective R1.1.5	(Creating) Design, or redesign, safe and effective patient-centered therapeutic regimens and monitoring plans (care plans) for critically ill patients.
Objective R1.1.6	(Applying) Ensure implementation of therapeutic regimens and monitoring plans (care plans) for critically ill patients by taking appropriate follow up actions.
Objective R1.1.7	(Applying) For critically ill patients, document direct patient care activities appropriately in the medical record, or where appropriate.
Objective R1.1.8	(Applying) Demonstrate responsibility to critically ill patients for patient outcomes.
Goal R1.2	Ensure continuity of care during transitions of critically ill patients between care settings.
Objective R1.2.1	(Applying) Manage transitions of care effectively for critically ill patients.
Competency Area R2: Advancing Practice and Improving Patient Care
Goal R2.1	Demonstrate ability to manage formulary and medication-use processes for critically ill patients, as applicable to the organization.
Objective R2.1.1	(Creating) Prepare or revise a drug class review, monograph, treatment guideline, or protocol related to care of critically ill patients, including proposals for medication-safety technology improvements.
Objective R2.1.2	(Evaluating) Participate in a medication-use evaluation related to care for critically ill patients.
Objective R2.1.3	(Applying) Participate in the review of medication event reporting and monitoring related to care for critically ill patients.
Objective R2.1.4	(Analyzing) Identify opportunities for improvement of the medication-use system related to care for critical care patients.
Competency Area R3: Leadership and Management
Goal R3.1	Demonstrate leadership skills for successful self-development in the provision of care for critically ill patients.
Objective R3.1.1	(Applying) Demonstrate personal, interpersonal, and teamwork skills critical for effective leadership in the provision of care for critically ill patients.
Objective R3.1.2	(Applying) Apply a process of ongoing self-evaluation and personal performance improvement in the provision of care for critically ill patients.
Goal R3.2	Demonstrate management skills in the provision of care for critically ill patients.
Objective R3.2.1	(Applying) Contribute to critical care pharmacy departmental management.
Objective R3.2.2	(Applying) Manage one's own critical care practice effectively.
Competency Area R4: Teaching, Education, and Dissemination of Knowledge
Goal R4.1	Provide effective medication and practice related education to critically ill patients, caregivers, health care professionals, students, and the public (individuals and groups).
Objective R4.1.1	(Applying) Design effective educational activities related to critical care pharmacy.
Objective R4.1.2	(Applying) Use effective presentation and teaching skills to deliver education related to critical care pharmacy.
Objective R4.1.3	(Applying) Use effective written communication to disseminate knowledge related to critical care pharmacy.
Objective R4.1.4	(Applying) Appropriately assess effectiveness of education related to critical care pharmacy.
Goal R4.2	Effectively employ appropriate preceptor roles when engaged in teaching students, pharmacy technicians, or fellow health care professionals in critical care.
Objective R4.2.1	(Analyzing) When engaged in teaching related to critical care, select preceptor role that meets learners' educational needs.
Objective R4.2.2	(Applying) Effectively employ preceptor roles, as appropriate, when instructing, modeling, coaching, or facilitating skills related to critical care.

Requirements for Graduation

In addition to the requirements listed in "Requirements for Graduation," the PGY2 Critical Care resident must also complete the following activities/projects.

Update Disease State Tracker quarterly
Complete and present a medication use evaluation
Complete and present and order set/protocol and develop education related to it
Complete 1 ACPE-accredited CE presentation
Complete 2 journal club presentations
Complete 2 required 30 minute presentations
Lead 7 topic discussions for students
Develop and present skills lab to PGY3 students

Updated 6/2023

PGY2 Infectious Disease Program

Purpose

In addition to ASHP purpose of PGY2 residency programs, the PGY2 Infectious Diseases Pharmacy Residency Program at University of Mississippi Medical Center exists to achieve three main overarching goals.

To develop confident and competent infectious diseases practitioners.
To promote a desire for pursuit and participation in infectious diseases research.
To develop well-rounded educators effective in teaching current health care professionals and health care professionals in training.

Structure

Required Rotations		Elective Rotations
Monthly	Longitudinal	Monthly*
Adult Infectious Diseases I	Infection Prevention and Control Experience	Academia
Adult Infectious Diseases II	Infectious Diseases Pharmacy Practice/Practice Management	Adult Infectious Diseases III
Antimicrobial Stewardship I & II (UMMC)	Research	Outpatient Antimicrobial Service (OAS)
Antimicrobial Stewardship III (UMMC or St. Dominic)	Staffing Service	Community Antimicrobial Stewardship
Microbiology	Teaching and Preceptorship	Pediatric Infectious Diseases
		Transplant ID
		Research

*Any required rotations may be repeated as electives

ASHP competency areas, goals and objectives are selected for the PGY2 Infectious Diseases Residency Program to meet the program's purpose. Residents are required to familiarize themselves with objectives associated with each goal. Objectives are intended to be matched with specific activities outlined in each learning experience. Achievement of all objectives for a specified goal will signify achievement of the associated goal and achievement of all goals for a specified outcome will signify achievement of the associated competency area.

Required Competency Areas, Goals, and Objectives

Competency Area R1: Patient Care
Goal R1.1	In collaboration with the health care team, provide comprehensive medication management to patients with infectious diseases following a consistent patient care process.
Objective R1.1.1	(Applying) Interact effectively with health care teams, including microbiologists and infection control preventionists, to manage medication therapy for patients with infectious diseases.
Objective R1.1.2	(Applying) Interact effectively with infectious diseases patients, family members, and caregivers.
Objective R1.1.3	(Analyzing) Collect information on which to base safe and effective medication therapy for infectious diseases patients.
Objective R1.1.4	(Analyzing) Analyze and assess information on which to base safe and effective medication therapy for infectious diseases patients.
Objective R1.1.5	(Creating) Design, or redesign, safe and effective patient-centered therapeutic regimens and monitoring plans (care plans) for critically ill patients.
Objective R1.1.6	(Applying) Ensure implementation of therapeutic regimens and monitoring plans (care plans) for critically ill patients by taking appropriate follow up actions.
Objective R1.1.7	(Applying) For critically ill patients, document direct patient care activities appropriately in the medical record, or where appropriate.
Objective R1.1.8	(Applying) Demonstrate responsibility to critically ill patients for patient outcomes.
Goal R1.2	Ensure continuity of care during transitions of critically ill patients between care settings.
Objective R1.2.1	(Applying) Manage transitions of care effectively for critically ill patients.
Goal R1.3	Manage antimicrobial stewardship activities.
Objective R1.3.1	(Analyzing) Demonstrate an understanding of the integral members of the stewardship team, their roles, and the antimicrobial stewardship strategies used by organizations.
Objective R1.3.2	(Applying) Participate in the institution’s antimicrobial stewardship program
Objective R1.3.3	(Evaluating) Evaluate stewardship program processes and outcomes.
Competency Area R2: Advancing Practice and Improving Patient Care
Goal R2.1	Demonstrate ability to manage formulary and medication-use processes for critically ill patients, as applicable to the organization.
Objective R2.1.1	(Creating) Prepare or revise a drug class review, monograph, treatment guideline, or protocol related to care of critically ill patients, including proposals for medication-safety technology improvements.
Objective R2.1.2	(Evaluating) Participate in a medication-use evaluation related to care for critically ill patients.
Objective R2.1.3	(Applying) Participate in the review of medication event reporting and monitoring related to care for critically ill patients.
Goal R2.2	Demonstrate ability to conduct a quality improvement or research project.
Objective R2.2.1	(Analyzing) Identify and/or demonstrate understanding of a specific project topic to improve patient care related to care of patients with infectious diseases or topics related to advancing the pharmacy profession or infectious diseases pharmacy
Objective R2.2.2	(Creating) Develop a plan or research protocol for a practice quality improvement or research project related to the care of patients with infectious diseases or topics related to advancing the pharmacy profession or infectious diseases pharmacy.
Objective R2.3.3	(Evaluating) Collect and evaluate data for a practice quality improvement or research project related to the care of patients with infectious diseases or topics related to advancing the pharmacy profession or infectious diseases pharmacy.
Objective R2.2.4	(Applying) Implement quality improvement or research project to improve patient care related to care for patients with infectious diseases or topics related to advancing the pharmacy profession or infectious diseases pharmacy.
Objective R2.2.5	(Evaluating) Assess changes or need to make changes to improve patient care related to care for patients with infectious diseases or topics related to advancing the pharmacy profession or infectious diseases pharmacy.
Objective R2.3.6	(Creating) Effectively develop and present, orally and in writing, a final project report suitable for publication related to care for patients with infectious diseases or topics related to advancing the pharmacy profession or infectious diseases pharmacy at a local, regional, or national conference. (The presentation can be virtual.)
Goal R2.3	Manage and improve anti-infective-use processes.
Objective R2.3.1	(Evaluating) Make recommendations for additions or deletions to the organization’s anti-infective formulary based on literature and/or comparative reviews.
Objective R2.3.2	(Creating) Contribute to the activities of the P&T committee, specifically the anti-infective subcommittee, when applicable
Competency Area R3: Leadership and Management
Goal R3.1	Demonstrate leadership skills for successful self-development in the provision of care for critically ill patients.
Objective R3.1.1	(Applying) Demonstrate personal, interpersonal, and teamwork skills critical for effective leadership in the provision of care for critically ill patients.
Goal R3.2	Demonstrate management skills in the provision of care for critically ill patients.
Objective R3.2.1	(Applying) Contribute to critical care pharmacy departmental management.
Objective R3.2.2	(Applying) Manage one's own critical care practice effectively.
Goal R3.3	Demonstrate management skills in the provision of care for infectious diseases patients.
Objective R3.3.1	(Applying) Contribute to management of infectious diseases-related policies and issues.
Objective R3.3.2	(Applying) Manage one’s own infectious diseases practice effectively.
Competency Area R4: Teaching, Education, and Dissemination of Knowledge
Goal R4.1	Provide effective medication and practice related education to critically ill patients, caregivers, health care professionals, students, and the public (individuals and groups).
Objective R4.1.1	(Applying) Design effective educational activities related to critical care pharmacy.
Objective R4.1.2	(Applying) Use effective presentation and teaching skills to deliver education related to critical care pharmacy.
Objective R4.1.3	(Applying) Use effective written communication to disseminate knowledge related to critical care pharmacy.
Objective R4.1.4	(Applying) Appropriately assess effectiveness of education related to critical care pharmacy.
Goal R4.2	Effectively employ appropriate preceptor roles when engaged in teaching students, pharmacy technicians, or fellow health care professionals in critical care.
Objective R4.2.1	(Analyzing) When engaged in teaching related to critical care, select preceptor role that meets learners' educational needs.
Objective R4.2.2	(Applying) Effectively employ preceptor roles, as appropriate, when instructing, modeling, coaching, or facilitating skills related to critical care.

Requirements for Graduation

In addition to the requirements listed in "Requirements for Graduation", the PGY2 Infectious Diseases resident must also complete the following activities/projects.

Update Disease State Tracker quarterly
Update Recommendation Tracker Monthly (when applicable for clinical months)
Complete and present a major research project (clinical, outcomes-based) verbally and in writing
Develop a protocol, policy, practice guideline, or class monograph/comparison
Complete 1 CE presentation to the ID Division
Complete required journal club presentations
Complete 2 required 30 minute presentations
Precept at least one student on a clinical rotation including leading topic discussions
Prepare a lecture or active-learning activity related to infectious diseases

Updated 6/2023

Program Administrators

Residency Program Director

The Residency Program Director (RPD) is responsible for the overall quality of each residency program. They coordinate resident and preceptor activities in order to assure an effective and well-organized learning experience. The RPD must meet certain requirements as set forth by ASHP. Qualifications of the RPD are found in the ASHP Accreditation Standards for each respective program.

Currently, the programs and program directors are as follows:

Program	Director
PGY1 Pharmacy	Sara R. Jones, PharmD, BCCCP
PGY2 Critical Care	Katherine Artman, PharmD, BCCCP
PGY2 Infectious Diseases	Kayla Stover, PharmD, BCIDP, BCPS

Residency Oversight Committee

The Residency Oversight Committee (ROC) consists of the RPDs of each program and the Director of Pharmacy. This committee exists to govern over the policies and procedures of the residency programs at the University of Mississippi Medical Center, in order to ensure compliance with the ASHP Accreditation Standards of each program. It will also serve as the governing body over decisions regarding program structure, preceptor appointment, and any issues regarding resident progression or discipline. The ROC will also meet to discuss and approve the final rank list prior to submission.

Residency Advisory Committee

Each RPD will appoint members from its preceptor body to serve as members of a residency advisory committee (RAC) and will serve as the chair of this committee. The RAC will meet several times each year (ideally quarterly) to discuss the respective residency program. This committee exists to make recommendations to the ROC committee regarding:

Changes to program structure
Plans for preceptor development and appointment
Resident progression and discipline
Resident graduation and awarding of certificate

The RAC will also be involved in each Quarterly Evaluation of the residents and will make recommendations to be included in the development plan of each resident. Any serious issues regarding resident progression may be addressed by this committee. The RAC will be involved in the resident selection process; will assist in determining the list of interview candidates; and will assist in the development of the final rank list.

Preceptor Development Taskforce

The ROC will appoint members from the preceptor body to serve as members of a preceptor development committee. This committee serves to:

Develop policies and procedures related to preceptor development
Develop and implement criteria for appointment and reappointment of preceptors
Create and implement a preceptor development plan for the residency program
- Determine preceptor needs
- Show effectiveness of plans/programs

PGY1 Residency Coordinators

The PGY1 RPD will select 1 or more preceptors to serve as coordinators of the residency program. These coordinators will assist the RPD with administrative tasks, applicant management and interviews, coordinating scheduling of some events and orientation, etc. They will also hold monthly meetings with the residents to ensure that tasks and requirements are being completed in a timely manner. They will report directly to the RPD any resident, preceptor, or site performance issues that arise.

Preceptors

Preceptors will be appointed and reappointed by the preceptor development subcommittee with approval from the ROC. Please see the preceptor development policy for more details.

Preceptors are responsible for:

Preparing and updating learning experience descriptions
Orienting residents to their learning experience prior to or on the first day of the learning experience
Completing midpoint evaluations in person and in PharmAcademic
Completing all summative evaluations in PharmAcademic within 7 days of completion of the learning experience
Meeting with the resident to discuss summative, self, and preceptor/learning experience evaluations
Submitting documentation of preceptor development activities to the preceptor development subcommittee

Mentors

Each pharmacy resident will choose a mentor by September 1. Mentors will be expected to:

Serve as professional mentors with regard to career development
- May assist with CV development, interview skills, etc.
Proofread projects for accuracy and grammar
Assist the RPD if issues arise with the resident
Meet with resident on a regular basis

Updated 6/2022

Recruitment and Selection of Residents

The applicant should be highly motivated with a desire to receive advanced training to enhance knowledge, skills, attitudes, and abilities related to the provision of direct patient care and project and practice management.

Application Requirements

The applicant must be enrolled in or be a graduate of and ACPE-accredited advanced pharmacy program or the equivalent.
Applicants must obtain a license to practice pharmacy and a controlled substance registration in the state of Mississippi within the first 60 days of residency.
Applicants to the PGY2 programs must be completing or have completed and ASHP-accredited PGY1 pharmacy residency or equivalent.
PhORCAS must be used to submit the following information.
- Application and CV
- Official transcripts
- Three letters of reference
  - PGY1 Requirements
    - At least 2 letters should be from clinical preceptors
  - PGY2 Critical Care Requirements
    - PGY1 RPD
    - PGY1 critical care preceptor
    - Any other PGY1 preceptor
- Letter of Intent

All rules and regulations of ASHP and the National Matching Service will be strictly followed.

Candidate Selection for Interviews

Members of the RAC will review applications using program specific applicant selection rubrics. These documents can be located on the Residency Oversight Committee shared page via OneDrive.
If the PhORCAS application is not "Complete" at the deadline for submission, the application will not be reviewed, and the candidate will not be considered for an interview.
The final selection of candidates for interviews is the responsibility of the RPD.

Interview and Evaluation of Candidates

An interview with RPD, departmental leadership, and residency preceptors is required.
- A virtual interview may be conducted if extenuating circumstances are present as determined by program leadership or in the event that a second match is needed.
- When the virtual interview option is selected, all applicants that application cycle will be interviewed virtually.
All participants in the interview process will complete an applicant evaluation.
The scores from these evaluations will be used to develop a preliminary rank list.
All participants in the interview process will be invited to attend a confidential session to discuss the preliminary rank list and candidate selection.
- Documentation of reason for candidate movement on rank list will be kept confidential.
The RPD is responsible for submitting the finalized rank list to the National Matching Service.

Procedure for Phase II Match Process

In the event that a UMMC Pharmacy Residency program does not match in Phase I of the National Pharmacy Match, the recruitment, review, and interview process will be as follows.

Recruitment:

Program leadership may recruit using social media, pharmacy contacts, or other means as deemed necessary.

Candidate Review and Invitations for Interviews:

Each program will decide the capacity for interviews at the beginning of the Phase II cycle based on the number of applicants and the number of available spots.
Candidates will be reviewed on a rolling basis until all available interview spots are filled or until the deadline has passed.

Candidates will be reviewed by at least two members of the Residency Advisory Committee.
Programs will use their individual rubrics to determine suitability for interviews.

Interview Process:

Interviews for Phase II will be conducted via a virtual platform.
Interviews may be altered from Phase I plans as needed to maximize time and efficiency.

 Ranking of Candidates and Submission of Ranks:

Candidates will be scored during the interview based on the program-specific rubric.
The process for ranking individuals will remain the same for Phase I and Phase II.

Please see separate PGY-2 ID Early Commitment Policy

Updated 4/2023

Resident Responsibilities and Expectations

Employment

After matching with our program, all residents must meet all requirements for hire as set forth by the University of Mississippi Medical Center. These include but are not limited to:
- Vaccination against certain infectious diseases (i.e., COVID-19, yearly influenza, etc.)
- Satisfactorily completion of a background check
For more information about Human Resources requirements, please consult the University of Mississippi Medical Center Human Resources office.

Licensure

PGY1 and PGY2 residents must obtain licensure in the state of Mississippi during the first 60 days of their residency program. Those who are not licensed at this time will be terminated.
Every effort should be made by the resident to be licensed prior to the beginning of residency.
PGY1 residents who are just graduating are highly encouraged to obtain intern licenses in the state of Mississippi to enable them to complete training during orientation, particularly if licensure is delayed.
The Mississippi Board of Pharmacy does not permit PGY2 residents to perform any patient care activities until they are fully licensed by our state and are limited to orientation only.

Documentation

PGY2 residents will present a copy of their PGY1 certificate during the first week of orientation. If the resident does not have a certificate, the RPD will contact the PGY1 residency program. If the resident did not complete their PGY1 program, they will be terminated.
Primary source verification of licensure for pharmacists is required by UMMC's HR department. Uploading proof of licensure to Workday (copy of license, screenshot of MS Board of Pharmacy license verification screen) is required.

Outside Employment and Duty Hours

Residents are not prohibited from procuring part time positions within or outside of the institution if needed.
- If residents procure part time positions outside of the institution, they are required by the UMMC HR department to fill out the Conflict of Interest form.
All shifts must be approved by the RPD via email prior to the time of beginning of the shift.
Residents are required to comply with the ASHP Duty-Hour Requirements for Pharmacy Residencies (external link).
- Residents are allowed to work a maximum of 20 hours per calendar month.
- If there are extenuating circumstances, the ROC will meet on a case by case basis to discuss additional hours.
Hour tracking
- Residents will be clock into the Kronos system for each shift at our institution. For those procuring positions outside of the institution, they must document shifts worked and send to their RPD.
- Residents will attest in PharmAcademic each month that they are following the ASHP Duty-Hour Requirements.  
- If outside work is deemed to affect the resident’s performance in any way, they will be asked to decrease the hours of outside work. The resident will be entered into the progressive disciplinary process at this time.   
  - More intensive hour tracking will begin with limits placed around hours worked outside normal duties, up to cessation of outside employment.

Updated 9/2022

Resident Expectations

Residents are expected to become fully integrated members of the Department of Pharmacy. As such, they are expected to:

Abide by all policies and the values of the organization at all times.
Become familiar with the Department of Pharmacy Services Policies and Procedures Manual available on the intranet during their orientation period.
Be present and punctual for all assigned activities.
1. Tardiness is not tolerated and will be enforced according to the Institution's Attendance Policy.
2. Any unusual situation causing the resident to be absent, late, or leave early should be communicated to the preceptor and the RPD.
3. Timely communication regarding requested leave is expected. Failure to inform the RPD of an absence or illness will result in disciplinary action.
4. Attendance at all resident activities (CE, Journal Club, Therapeutics, etc.) is expected. Any absence or tardiness should be communicated to and approved by the RPD beforehand.
Act and present himself or herself in a responsible and professional manner. Residents are to comply with the departmental dress code. Scrubs are permitted so long as they are permitted by the preceptor of the learning experience.
Participate in staffing activities in the Department of Pharmacy Services
1. Residents will participate in scheduled pharmacy staffing longitudinal experience in the Department of Pharmacy Services.
2. While every effort will be made to not interrupt rotation experiences for normal staffing issues, residents may be asked to assist with staffing in the event of an emergency, disaster, or other unusual staffing circumstance.
Comply with rotation expectations, to include:
1. Meeting with the rotation preceptor to define individual goals and objectives for the rotation
2. Completing assignments by the end of rotation
3. Scheduling routine meetings with the rotation preceptor
4. Informing the rotation preceptor of scheduled meetings and days off during the rotation
5. Informing the residency director of difficulties encountered in meeting goals and objectives or problems with preceptors
6. Assuming responsibility of the rotation preceptor in his/her absence
7. Completing all PharmAcademic at the conclusion of each rotation and quarterly for longitudinal requirements. These must be done in a timely manner.
Completion of all requirements for graduation (see "Requirements for Graduation")
Attendance at pharmacy meetings
1. PGY1: ASHP Midyear Clinical Meeting
2. PGY2: National meeting of the RPD's choice in the subject area
3. Regional residency research conference
4. Residents may attend other professional meetings if the staffing schedule permits. These meetings may not be funded by the institution, depending on funds.

Attendance and Leave

Short term absences
- Residents are full employees of the institution and thus accrue personal and medical leave benefits.
- Residents should be present for 85% of available rotation days, not including sick leave or compensation time off. The total allowable number of days off shall not exceed the number determined by ASHP Standards.
- Any other personal time off must be approved by the preceptor and RPD via email and Workday. Available rotation days do not include weekends or compensated time off after working a scheduled staffing weekend.
- If residents need more days off, it should be approved by the ROC no later than 30 days prior to the request.
- Leave for professional meetings must be entered into Workday as “Training” time.
- UMMC requires that the first 8 hours of any absence for medical reasons be coded as personal. Remaining time off for the same illness can be coded as medical leave time.
- Any call in for sickness or other emergency should be communicated with the preceptor and RPD as soon as possible, and entered in Workday.
Leave of absence and/or family medical leave
- Employees that have completed the initial period of employment may be granted a leave of absence without pay for further education or other personal reasons at the discretion of the Department Head and the Residency Director.
- This leave of absence will not be greater than 3 weeks during the residency program to ensure that the residency requirements are met and will necessitate that the resident completes the program without compensation at a later date. As much advance notice should be provided the Residency Director and Director of Pharmacy Services as possible. A plan for completion of the residency program should be discussed at the time of the request and shall be approved by the ROC.
- If longer than 3 weeks is medically required, the ROC will consult with the HR department and evaluate on a case by case basis.
- Family medical leave is available for medical center employees. Employees must meet the criteria set forth by the Human Resources (HR) Department to qualify for leave. See HR policies for more information.
- Leave will necessitate that the resident completes the residency program without compensation at a later date. As much advance notice should be provided the Residency Director and Director of Pharmacy Services as reasonably possible. A plan for completion of the residency program should be discussed at the time of the request and shall be approved by the ROC.
- All requirements for graduation must still be completed prior to receiving a certificate.

Updated 7/2022

Failure to Progress and Dismissal

Significant deficiencies noted during any learning experience should be addressed by the preceptor during resident feedback, midpoint, and final evaluations. If the behavior or deficiencies still exist at the final evaluation (may be sooner for longitudinal experiences), the preceptor should discuss with the RPD and denote the deficiencies with NI on their PharmAcademic evaluations.

In such cases, appropriate remedial action will be undertaken after discussion with the RPD, RAC, and ROC. If the RAC and ROC deem appropriate, a performance improvement plan (PIP) will begin. The plan will be written out and signed by the resident, RPD, and Director of Pharmacy and will include objectives, along with activities and due dates of the objectives. The plan should be as specific as possible to give clear expectations and a plan for follow-up. During this time, the resident will meet with the RPD or another designee/mentor on a routine basis (not to be less than every other week but may be more frequent).

If the resident does not successfully complete the remediation, the ROC will review the assessments and determine the next course of action, up to and including dismissal from the program. Any extra time required to complete remediation after the end of residency will be uncompensated.

In conjunction with the PIP and with the approval of HR, the resident will enter in the progressive disciplinary process at this time, as well.

If a resident displays any gross unprofessionalism or misconduct, they will be disciplined according to the Department of Pharmacy and UMMC Human Resources policies, up to and including termination. A resident does not have a property right to his/her job or academic training and may be terminated with or without cause.

Updated 1/2020

Requirements for Graduation

In addition to each program's specific graduation requirements (available in the program specific sections above), residents will also be required to meet the following requirements.

Earn ACHR for ≥ 80% of the required objectives of the residency program.
No objective can have a final assessment of Needs Improvement.
Completion of a research project.
- The results should be presented at a regional residency conference.
- A final report must be submitted in the style of a manuscript.
Submission of a completed electronic notebook to the RPD that includes all projects, presentations, evaluations, and proposals. See list in program specific section for complete requirements for each program.
Completion of all staffing service shifts.
Submission of all PharmAcademic evaluations for monthly and longitudinal learning experiences.

Updated 7/2022

Preceptor Responsibilities and Expectations

Evaluations

The following definitions will be used for all programs to document resident performance on evaluations.

Progression	Description
Needs Improvement (NI)	Resident's level of skill on the goal does not meet the expected level and specific modifications will be required Resident was unable to complete assignments on time and/or required significant preceptor oversight Resident's aptitude or clinical abilities were deficient Unprofessional behavior was noted
Satisfactory Progress (SP)	Resident's skill level has progressed at a rate that will result in full mastery by the end of the residency program Resident performs skill with some assistance from the preceptor Improvement is evident throughout the experience
Achieved (ACH)	Resident has fully mastered the goal/skill based on their residency training Resident has performed the skill consistently with little or no assistance from the preceptor
Achieved for Residency (ACHR)	May only be designated by RPDs based on review and assessment of summative evaluations. RPD will mark ACHR when the resident receives 2 ACH for a goal/objective or 1 ACH on the final evaluation

Feedback to the resident shall be provided by the preceptor during each rotation at least weekly. Real-time self-evaluation is expected and encouraged from the residents.

Evaluation Timeliness

All evaluations will be completed in PharmAcademic within 7 days of the end of the learning experience. Periodically, an overdue evaluation report in PharmAcademic will be run. Those individuals will be notified of the delinquency and expected to complete the evaluation ASAP.

Clinical pharmacists serving as preceptors will be granted 1 hour of administrative time to complete summative evaluations. It is the responsibility of the pharmacist to arrange coverage in advance.

Summative Evaluations

The preceptor will provide and review rotation-specific ASHP Goals and Objectives and associated learning activities with the resident at the beginning of each learning experience.

All evaluations that do not include the appropriate comments will be sent back by the RPD for edits.

Summative Evaluation by the Preceptor

Preceptors should elaborate in the comments section of each objective unless denoted as ACHR so the resident knows the quality of his or her performance. Specific examples should be included as to how the resident is working to meet the objective. Specific examples of what the resident needs to do in order to achieve a goal should also be included.

Summative Evaluations by the Residents

Self-evaluation and reflection is required of all residents. The resident should consider and make comments regarding actions taken, quality of performance, learning points, and improvements to make for each objective.

Resident's Evaluation of the Preceptor

An evaluation of the preceptor's performance will be completed by the resident at the end of a monthly learning experience and at least quarterly for longitudinal experiences. The preceptors and RPD will both cosign this evaluation. These evaluations should include strengths of the preceptors and ways to make future experiences more valuable to residents.

Resident's Evaluation of the Learning Experience

An evaluation of the learning experience will be completed by the resident at the end of a monthly learning experience and at least quarterly for longitudinal experiences. The most valuable aspects of the learning experience as well as improvements should be documented.

Quarterly Evaluation

Each quarter, an assessment will be conducted with the RAC that will review learning experience assessments and progress with projects, research, and residency requirements for the resident. The RPD will discuss the assessment with the resident and identify methods to enhance learning as well as to strengthen areas for improvement. The RPD and resident will then complete a written update to the resident's customized training plan that reflects the discussion and findings from the meeting.

Updated 1/2020

Preceptor Policies

The University of Mississippi Medical Center pharmacists will serve as preceptors for the residents on the majority of their rotations. Additionally, the University of Mississippi School of Pharmacy (UMSOP) faculty and occasionally nonpharmacists may serve in instructor and/or preceptor roles.

UMMC PGY-1 Pharmacy Preceptors: The following requirements are in place for UMMC pharmacists serving as residency preceptors in our PGY-1 program:

Licensed pharmacist who meets one of the following requirements:
- Completed an ASHP-accredited PGY1 residency followed by a minimum of one year of pharmacy practice experience in the area precepted; or
- Completed an ASHP-accredited PGY1 residency followed by an ASHP-accredited PGY2 residency and a minimum of six months of pharmacy practice experience in the area precepted; or
- Not completed an ASHP-accredited residency but has three or more years of pharmacy practice experience in the area precepted
Contributes to the success of residents and the program
Provides learning experiences in accordance with Standard 3
Participates actively in the residency program's continuous quality improvement processes
Demonstrates practice expertise, preceptor skills, and strive to continuously improve
Adheres to residency program and department policies pertaining to residents and services
Demonstrates commitment to advancing the residency program and pharmacy services
Demonstrates the ability to precept residents' learning experiences by use of clinical teaching roles (i.e., instructing, modeling, coaching, facilitating) at the level required by residents
Assesses residents' performance
Is recognized in the area of pharmacy practice for which they serve as preceptors
Has an established, active practice in the area for which they serve as preceptor
Maintains continuity of practice during the time of residents' learning experiences
Shows ongoing professionalism, including a personal commitment to advancing the profession

UMMC PGY2 Pharmacy Preceptors: PGY-2 preceptors will have completed a PGY-2 residency plus one year of relevant experience or will have practiced extensively in the area they preceptor and have at least 3 years of experience. Preceptors must be actively practicing in the area in which they serve as preceptors.

University of Mississippi School of Pharmacy (UMSOP) Faculty: UMSOP faculty members are utilized to provide preceptorship for certain specialty areas. These faculty members will be designated as preceptors and must meet all ASHP preceptor requirements, participate in preceptor development, and adhere to all UMMC policies and procedures.

Non-Pharmacist Preceptors: Occasionally, it may be appropriate to use non-pharmacists as primary preceptors to give the resident experience in areas where there is no pharmacist practitioner. These situations are expected to be rare and must meet the following criteria:

The non-pharmacist preceptor will receive information about the residency program, including purpose, structure, outcomes, teaching methods, evaluation, etc.
A UMMC preceptor will be assigned as a liaison to this rotation and will ensure that all training is appropriate – he/she will be in contact with the non-pharmacist preceptor on a regular basis and will participate in the evaluation process
A resident may take only one such rotation per year and it will be scheduled when resident is ready for independent practice.

Preceptor Development: The ROC and Residency Preceptor Development Committee (RPDC) will conduct a preceptor development program to ensure the quality of all preceptors. All pharmacist preceptors will be required to participate in this process. Additionally, the RPD and RPDC will ensure that all preceptors are providing adequate orientation, instruction, and feedback to the residents.

Quality Improvement: The ROC and RPDC will spearhead a continuous quality improvement assessment for the residency programs with regard to preceptor development. This will ensure compliance with ASHP standards and serve to improve upon cited deficiencies within the program.

Newly Appointed Preceptors: The RPD of the program and RPDC will design a preceptor training program for each newly appointed preceptor. Elements of this program are outlined in the Preceptor Development Policy and will be evaluated with the checklist that can be found in Appendix 5:

Review of basic precepting concepts, conducted by RPD, RPDC and designee(s)
Review of the residency manual for preceptors, conducted by RPD or RPDC
Assignment of a clinical advisor and appointment of a RPDC committee liaison for each new preceptor by the RPD or RPDC
Review and observation of the four experiential teaching roles, conducted by RPD, RPDC and/or designee(s)
Attendance at preceptor development programs
Attainment of ASHP preceptor eligibility requirements, signed off by RPD or RPDC
Understanding and application of ASHP required preceptor responsibilities
Meets all ASHP required preceptor qualifications
Complete preceptor qualifications within 2 years

Updated 6/2023

Process for becoming a pharmacy residency preceptor at UMMC

Submit application to RPD and RPDC for approval
Begin work on meeting ASHP preceptor criteria (see "UMMC PGY-1 Pharmacy Preceptor" section in the Policy on Preceptors document) – start immediately
Co-precept residents - can begin training with current residents based on clinical practice area
Formal training on various concepts
1. Residency manual
2. Rotation design and set-up
3. Orientation
4. Instruction
5. Evaluation process
Sign off preceptor qualifications within 24 months

Updated 6/2023

Preceptor Development Policy

Purpose:

Improve and maintain the quality of preceptors associated with the University of Mississippi Medical Center (UMMC) pharmacy residency programs in accordance with the American Society of Health-Systems Pharmacists (ASHP) standards.

Involvement:

Residency Oversight Committee (ROC)

Residency Preceptor Development Committee (RPDC)

Residency Preceptors

Structure:

The preceptor development program will consist of various educational programs, meetings with preceptors, and other activities deemed appropriate by the RPDs or RPDC as needed.

Assessment of Preceptor Development Needs:
- The RPDC will review residents' evaluations of preceptors and preceptor self-evaluations and learning experiences annually to identify potential preceptor development needs.
- The RPDC will request verbal feedback from residents annually or as needed.
- The RPDC will review ASHP residency accreditation site visit recommendations, if applicable, to identify any recommendations or areas of partial compliance which pertain to precepting skills
Development Process for Annual Preceptor Development Plan:
- Preceptor development needs identified through the assessment process will be discussed annually as part of the annual end-of-year preceptor meeting.
- The RPDC will determine the areas of preceptor development to focus on during the upcoming residency year.
- The RPDC will present a tentative preceptor development plan and schedule of activities for the upcoming residency year to address areas of need to the Residency Advisory Committee (RAC) at the last scheduled RAC meeting.
- If preceptor development needs have been identified for individual preceptor(s) which will not be met by the current preceptor development plan, the RPDC may also develop individual plans for these preceptors.
Review of Effectiveness of Previous Residency Year's Plan:
- Review of current preceptor development plan and attendance will occur annually at the end-of-year preceptor meeting.
- Effectiveness of the plan will be assessed as follows:
  - Review of current preceptor needs assessment survey results to determine if any needs addressed through preceptor development activities in the past residency year are still identified as top areas of need.
  - Discussion with preceptors of the effectiveness of activities utilized during the past year to address preceptor development needs.
  - Review of participation to ensure preceptors and preceptors in training have participated in at least 4 preceptor development activities throughout the residency year
- Discussion of the effectiveness of previous year's plan will be utilized when developing topics, scheduling, and preceptor development activities for upcoming year.
Requirements for Newly Appointed Preceptors:
- RPDC member to discuss "Guidance Document for the ASHP Accreditation Standard for Post-Graduate Year One (PGY1) Pharmacy Residency Programs" with new preceptors.
- RPDC member to discuss UMMC Residency Manual and preceptor expectations with new preceptors.
- New preceptors will complete assigned educational content from the RPDC.
- RPDC will develop an individual plan designed to ensure new preceptors will meet all ASHP preceptor requirements within two years.
- Newly Appointed Preceptors
  - A clinical advisor will be appointed to each newly appointed preceptor. This clinical advisor will act as a mentor, observe preceptor's interaction with residents, and will co-sign any summative evaluations completed by the new preceptor.
Other Opportunities for Preceptor Development for UMMC Preceptors
- Preceptors may attend programs locally, regionally, or nationally to advance their precepting skills.
- Preceptors who attend said programs will be responsible for sharing information to the preceptors as appropriate.
- Material for self-study will be identified and distributed per the RPDC.
- The University of Mississippi School of Pharmacy, ASHP, APhA, Pharmacist Letter, etc will be utilized to advance preceptor development.

Updated 6/2023

Wellness

Residents will be provided with ASHP and UMMC resources for well-being and resilience during orientation:

UMMC - Employee Assistance Program and Wellness resources
ASHP - webinars, articles, tips, etc for improving wellbeing and resilience

Residents will choose a professional mentor by September 1. Mentors chosen by the residents will join torgether and assist with planning well-being and team-building activities.

Well-being and burnout will be assessed regularly:

During monthly meetings with coordinators and/or mentors for PGY1 residents
- This will be discussed at each quarterly evaluation and included in the development plans for each PGY1 resident.

Updated 6/2022

Crisis Management

The Crisis Management Team will consist of the PGY-1 RPD, all PGY-2 RPDs, and the director of pharmacy. Other team members will be brought in on an as needed basis. The team will convene in the event of serious illness/injury or death of a pharmacy resident, preceptor, or program director.

Responsibilities of the Crisis Management Team include:

Maintenance of up to date contact information for all residents
Maintenance of up to date emergency contact information for all residents
- This information will be found on the ROC OneDrive page
Missing resident procedure
- If a resident is 30 minutes late reporting to rotation or a scheduled shift, the preceptor should notify the resident's RPD.
- The RPD will attempt to contact the resident via phone, email, and text.
- If resident is not accounted for within 1 hour, the RPD may contact the resident's emergency contact.
- If there is no resolution after discussion with the resident's emergency contact, the local authorities may be called for a welfare check.
Notification and support those individuals affected
- The RPD of the resident involved will be primarily responsible for resident support and family contact.
- The remaining team members will be responsible for notifying relevant individuals and supporting the affected program.
Residents will not be expected to cover open shifts left vacant due to serious illness/injury or death.

Updated 1/2020

Department of Pharmacy Residencies

Pharmacy Residency Programs Manual

Table of Contents

Select a topic to jump to a section.

Introduction

PGY1 Pharmacy Residency Program

Purpose

Structure

Required Competency Areas, Goals, and Objectives

Requirements for Graduation:

PGY2 Pharmacy Residency Programs

PGY2 Critical Care Program

Purpose

Structure

Required Competency Areas, Goals, and Objectives

Requirements for Graduation

PGY2 Infectious Disease Program

Purpose

Structure

Required Competency Areas, Goals, and Objectives

Requirements for Graduation

Program Administrators

Residency Program Director

Residency Oversight Committee

Residency Advisory Committee

Preceptor Development Taskforce

PGY1 Residency Coordinators

Preceptors

Mentors

Recruitment and Selection of Residents

Application Requirements

Candidate Selection for Interviews

Interview and Evaluation of Candidates

Procedure for Phase II Match Process

Resident Responsibilities and Expectations

Employment

Licensure

Documentation

Outside Employment and Duty Hours

Resident Expectations

Attendance and Leave

Failure to Progress and Dismissal

Requirements for Graduation

Preceptor Responsibilities and Expectations

Evaluations

Evaluation Timeliness

Summative Evaluations

Summative Evaluation by the Preceptor

Summative Evaluations by the Residents

Resident's Evaluation of the Preceptor

Resident's Evaluation of the Learning Experience

Quarterly Evaluation

Preceptor Policies

Process for becoming a pharmacy residency preceptor at UMMC

Preceptor Development Policy

Purpose:

Involvement:

Structure:

Wellness

Crisis Management

Appendices

Select an appendix below for more information and/or to view a form.