Maryland Department of Health and Mental Hygiene J-1 Visa Waiver Policy

Table of Contents
! #! C! P"rpose ... 1 #ac$gro"nd 1 Criteria and Policies for J-1 %&change Visitor 'J-1 Physician( .. 2 1. Residency Training Program . 2 2. Documentation .. 2 3. a. Contract Hours 2 b. Work-location . 3 c. dditional !m"loyment .. 3 d. #on-com"ete "ro$ibition .... 3 e. %#TC re&uirements ... ' (. PC) role .. ' g. Timeline (or contract submission ' '. cce"t all "atients regardless o( ability to "ay .. ' *. +onitoring . ' ,. Recruitment (ee "ro$ibition .. ' -. .eri(ication o( !m"loyment . * /. #oti(ication o( disci"linary action0termination . * 1. Conditions leading to and conse&uences o( de(ault .. * Medical Practice Criteria and Policies ... 1. 2$ortage designation re&uirement . 2. 2tatement o( need .. 3. Contract term0com"ensation . '. greement to ser3e t$e underser3ed *. Work-site documentation re&uirements ... ,. nnual re"orting re&uirements . -. #otice o( disci"linary action and0or termination .. /. Credentialing . 1. +edical Practice 2u""lement greement . 14. .eri(ication o( Re"resentation greement ... 11. Prior Re&uirement !((ort .. 12. gree to com"ly 13. +onitoring 1'. Conditions leading to and conse&uences o( de(ault .. 1*. #ote on PC) role in contracts .. 1,. !m"loyer ttestation Transfers ... pplication Process .. +etters of s"pport for federal agency sponsorship ... ,tate Contact . * * * * * , , , , , , , / 1 14

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Maryland Department of Health and Mental Hygiene J-1 Visa Waiver Policy
! P"rpose To im"ro3e access to $ealt$care ser3ices in underser3ed areas in +aryland5 t$e 2tate o( +aryland5 t$roug$ t$e De"artment o( Healt$ and +ental Hygiene6s 7DH+H8 )((ice o( Primary Care ccess6s Primary Care )((ice 7PC)85 recommends &uali(ied "$ysicians 9$o $a3e a""lied (or :-1 .isa Wai3ers. T$e "ur"ose o( t$is Policy is to s"eci(y t$e conditions under 9$ic$ t$e 2tate may s"onsor t$ese "$ysicians5 and 9$en t$e 2tate may 9rite letters o( su""ort (or (ederal agency s"onsors$i". #! #ac$gro"nd ;ederal la9s allo9 (oreign "$ysicians 9$o $a3e a 3alid :-1 !<c$ange .isitor .isa to "ursue graduate medical education or training in t$e =nited 2tates 7=.2.8. T$e :-1 .isa allo9s "$ysicians to remain in t$e =.2. until t$eir studies or training is com"leted. Ho9e3er5 u"on com"letion o( t$eir "rogram5 t$e "$ysicians must return to t$eir $ome country (or at least t9o years be(ore t$ey 9ill be able to return to t$e =.2. P$ysicians 9$o are sub>ect to5 but do not 9is$ to com"ly 9it$ t$e t9o-year $ome country residence re&uirement may a""ly (or a 9ai3er o( t$at re&uirement under any o( t$e (i3e grounds "ro3ided by t$e =.2. %mmigration and #ationality ct? 1. T$e e<c$ange 3isitor6s go3ernment must state t$at t$ey $a3e no ob>ection to t$e e<c$ange 3isitor not returning to t$e $ome country to satis(y t$e t9o-year (oreign residence re&uirement o( 2ection 2137e8 o( t$e %mmigration and #ationality ct5 as amended5 and remaining in t$e =.2. i( t$e e<c$ange 3isitor c$ooses to do so. %( t$e e<c$ange 3isitor is 9orking on a "ro>ect (or or o( interest to a =.2. ;ederal @o3ernment gency5 and t$at agency $as determined t$at t$e 3isitor6s continued stay in t$e =.2. is 3ital to one o( its "rograms5 a 9ai3er may be granted i( t$e e<c$ange 3isitor6s continued stay in t$e =.2. is in t$e "ublic interest. %( t$e e<c$ange 3isitor can demonstrate t$at $e0s$e 9ill be "ersecuted u"on return to t$e $ome country due to race5 religion5 or "olitical o"inion5 t$e e<c$ange 3isitor can a""ly (or a 9ai3er. %( t$e e<c$ange 3isitor can demonstrate t$at $is0$er de"arture (rom t$e =.2. 9ould cause e<treme $ards$i" to $is0$er =.2. citiAen or la9(ul "ermanent resident s"ouse or c$ild5 t$e e<c$ange 3isitor may a""ly (or a 9ai3er. 7T$e mere se"aration (rom (amily is not considered to be su((icient to establis$ e<ce"tional $ards$i".8 Pursuant to t$e re&uirements o( Public Ba9 143-'1,5 o( )ctober 2*5 111'5 (oreign medical graduates 9$o $a3e an o((er o( (ull-time em"loyment at a $ealt$ (acility in a designated $ealt$ "ro(essional s$ortage areaC sign a contract to begin em"loyment at suc$ a (acility 9it$in 14 days o( recei3ing suc$ 9ai3erC 9ork at t$e $ealt$ care (acility 9it$in 14 days o( recei3ing suc$ a 9ai3erC continue to 9ork at t$e $ealt$ care (acility (or a total o( '4 $ours "er 9eek5 and not less t$an t$ree yearsC may obtain a 9ai3er.

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T$e :-1 .isa Wai3er Program is a3ailable only to 7under t$e (ederal enabling la95 2ection 2245 PB 143-'1,8 an alien admitted to t$e =.2. as a nonimmigrant under 2ection 141 7a871*8 7:8 o( t$e ct5 or 9$o ac&uired status under t$at section a(ter admission to t$e =.2. to "artici"ate in an e<c$ange "rogram or graduate medical education or training 7as o( :une 15 111,8. C! Criteria and Policies for J-1 %&change Visitor 'J-1 Physician( To be eligible (or sponsorship and/or support by Maryland, including a letter of support, a "$ysician must?
1.

Com"lete a residency-training "rogram in (amily "ractice5 general "ediatrics5 general internal medicine5 obstetrics and gynecology5 or "syc$iatry 7Dmedical "racticeE8 and intend to "ractice in +aryland (or a "eriod o( t$ree consecuti3e years. P$ysicians 9it$ s"ecialty training 9ill also be considered5 as long as t$e residency-training re&uirement is also met (or t$e rele3ant s"ecialty. Pro3ide documentation o( success(ul com"letion o(? a. 2te"s 15 25 and 3 o( t$e =nited 2tates +edical Bicensing !<amination 7#ote? 2uccess(ul com"letion o( a &uali(ying e<amination in +aryland is a licensure re&uirement in t$is 2tate. !((ecti3e :uly 225 24425 an a""licant 9$o $as (ailed t$e e<am more t$an t$ree times is ineligible (or licensure and 9ill not recei3e 2tate su""ort (or s"onsors$i" o( a :-1 .isa Wai3er.8 7C)+ R 14.32.41.438C Bicense to "ractice medicine in t$e 2tate o( +aryland5 or "roo( o( a""lication to obtain oneC !ducational Commission (or ;oreign +edical @raduates Clinical 2kills ssessment certi(icationC and Residential training certi(ication.

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b. c. d.
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2ign an em"loyment agreement or contract 9it$ an eligible medical "ractice. T$e contract submitted 9it$ t$e Wai3er a""lication s$ould not be subse&uently altered 9it$out "rior a""ro3al o( t$e PC). !m"loyers s$ould not ask t$e :-1 "$ysician to sign addendums to t$e contract or to sign additional contracts nor s$ould t$e :-1 "$ysician sign any addendums or additional contracts 9it$out "rior a""ro3al o( t$e PC). T$e em"loyment agreement or contract must include? a. Contract Hours? 2tatement t$at t$e :-1 "$ysician 9ill "ractice a minimum o( '4 $ours "er 9eek 7at least 32 o( t$e re&uired '4 $ours must be in direct "atient care85 not including $os"ital rounds5 tra3el5 and on-call time5 (or not less or more t$an t$e re&uired t$ree 738 years5 at t$e a""ro3ed "ractice site listed on t$e site a""lication7s8. Candidates are also ad3ised to set ma<imum limits on t$e number o( $ours t$ey are contractually obliged to 9ork "er 9eek. lso note t$at a break in ser3ice e<ceeding ,4 days 9ill result in an e<tension o( t$e ser3ice obligation e&ual to t$e amount o( time o( t$e break in ser3ice. %( t$e "$ysician is absent (rom medical "ractice more t$an 1/4 consecuti3e days5 t$e "$ysician must submit to t$e PC)5 a 3eri(ication o( status statement. T$is statement must include? 18 t$e date 9$en t$e "$ysician sto""ed em"loymentC 28 t$e date t$e "$ysician e<"ects to return to 9orkC 38 t$e emergency reason as to 9$y t$e "$ysician $ad to be absent (or more t$an 1/4 consecuti3e daysC and '8 "$ysicianFs current address5 e-mail5 and 2

tele"$one number. T$e PC) is re&uired to re"ort all (indings to =.2. CitiAens$i" and %mmigration 2er3ices 7=2C%28 9$o $as t$e (inal say in t$e matter o( t$e "$ysicianFs immigration status. b. Work-site location? #ame and address o( all medical "ractice sites including $os"itals 9$ere t$e :-1 "$ysician 9ill be 9orking. %( t$e :-1 "$ysician 9ill 9ork at more t$an one site5 include t$e days and $ours o( "ractice at eac$ site and a breakdo9n in t$e amount o( time t$e "$ysician 9ill "ractice at eac$ site. :-1 .isa Wai3er candidates and em"loyers are encouraged to antici"ate issues t$at mig$t arise in seeking $os"ital "ri3ileges s$ould t$e need arise to obtain "ri3ileges at a $os"ital outside o( t$e a""ro3ed s$ortage area o( "ractice. !ac$ site listed s$ould also state 9$et$er or not it is located in a designated Healt$ Pro(essional 2$ortage rea 7HP2 8 or +edically =nderser3ed rea or +edically =nderser3ed Po"ulation 7+= 0P8. 2ites located in designated areas cannot be listed 9it$ sites located in non-designated areasC all sites must eit$er be designated or undesignatedGt$ey cannot mi<. Please note t$ere is a limit on t$e number o( 9ai3er a""lications t$at can be a""ro3ed (or sites t$at are not located in (ederally designated += s or HP2 s. Please go to http://datawarehouse.hrsa.gov/GeoAdvisor/ShortageDesignationAdvisor.aspx to see i( a site is located in a designated or undesignated area. dditional !m"loyment? #o moonlig$ting is allo9ed. ny additional or outside em"loyment in 9$ic$ t$e :-1 "$ysician engages must be sti"ulated in t$e original contract or added to a ne9 contract 9$ic$ must t$en be resigned by all "arties and resubmitted to t$e PC) (or recommendation (or =2C%2 a""ro3al. :-1 "$ysicians s$ould not sign contracts 9it$ ot$er em"loyers as t$is is in 3iolation o( t$e +aryland "ro$ibition o( moonlig$ting5 and in 3iolation o( t$e ;ederal regulations go3erning H1-H 3isa $olders. ;urt$er5 any em"loyment e<"ectations regarding $ours 9orked 3s. $os"ital rounds and0or on-call re&uirements must be s"eci(ied in t$e contractC t$e same a""lies to tra3el time. #on-com"ete "ro$ibition? #ot include a non-com"ete clause or restricti3e co3enants "re3enting or discouraging t$e :-1 "$ysician (rom continuing to "ractice in t$e ser3ice area o( (ormer em"loyment.

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%#TC re&uirements? Contain t$e contractual re&uirements set (ort$ in 2ection 21' 7k8 718 7H8 and 7C8 o( t$e %mmigration and #ationality Tec$nical Corrections ct!1 #ote on PC) role in contracts ? =nderstand t$at t$e PC) does not $a3e t$e aut$ority to mediate bet9een em"loyer and em"loyees "artici"ating in t$e :-1 "rogram5 to in3estigate allegations o( 9rongdoing (rom eit$er "arty5 or to en(orce labor standards. %( t$e PC) becomes a9are o( suc$ issues5 it 9ill recommend seeking ad3ice (rom an attorney or contacting t$e a""ro"riate agency 7i.e.5 +edicaid ;raud and buse5 De"artment o( Babor5 =nited 2tates CitiAens$i" and %mmigration 2er3ices8. ;urt$er5 t$e PC) assumes no res"onsibility (or negotiations or content o( em"loyment contracts or (or termination o( t$e contracts. Timeline (or Contract 2ubmission? 2tate t$at t$e :-1 "$ysician must begin 9ork 9it$in 14 days o( a""ro3al o( 9ai3er by =2C%2. T$us t$e PC) 9ill only re3ie9 a""lications o( "$ysicians 9$o are able to begin 9ork 9it$in (our mont$s o( a""lication.

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cce"t all "atients regardless o( ability to "ay. T$is includes ensuring t$at at least 34 "ercent o( "atients seen by :-1 .isa "$ysicians 9ill be made u" o( +edicaid or +edicare reci"ients or sliding-(ee scale "atients. sliding-(ee scale based on t$e (ederal "o3erty guidelines s$ould be used to discount ser3ices to lo9-income uninsured "ersons5 and notice must be "ro3ided to t$e "ublic t$at suc$ a "olicy is in e((ect. +onitoring? Hy signing t$is Policy5 t$e :-1 "$ysician agrees to be monitored by t$e PC) on a "eriodic basis (or com"liance 9it$ t$is agreement5 and "ro3ide documentation in t$e (orm re&uired by t$e De"artment5 2tate and ;ederal Ba9. co"y o( t$e +aryland 2ite +onitoring ;orm is a3ailable on t$e DH+H Web site. Recruitment (ee "ro$ibition? T$e :-1 "$ysician may not sign an em"loyment agreement or contract 9it$ an eligible medical "ractice t$at $as c$arged a recruitment (ee (or "$ysician re(errals recei3ed (rom t$e PC). T$e :-1 "$ysician s$ould submit a signed5 notariAed statement to t$e e((ect. .eri(ication o( !m"loyment? T$e :-1 "$ysician 9ill annually sign and submit a .eri(ication o( !m"loyment ;orm to t$e De"artment.

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P"blic +a- 1./-011 - 2ctober 345 16605 provides that7

Wai3er o( t$e T9o-Iear Home Country P$ysical Presence Re&uirement (or certain ;oreign +edical @raduates 2ection 224 o( t$e 111' Tec$nical Corrections ct created a ne9 section 21' 7k8 o( t$e ct5 setting terms and conditions im"osed u"on 2tate-based 9ai3ers including5 among ot$er t$ings t$at t$e ;oreign +edical @raduate 9ill? 7k8 718 D2ubmit to =2% a Jno ob>ection6 statement (rom t$e go3ernment o( $is or $er $ome country5 i( $e or s$e is contractually obligated to return to t$at countryC 7k8 728 Demonstrate an o((er o( (ull-time em"loyment at a $ealt$ care (acility located in an HH2-designated s$ortage area and agree to begin em"loyment 9it$in 14 days o( recei3ing t$e 9ai3er a""ro3alC 7k8 738 gree to "ractice medicine (or t$at $ealt$ care (acility (or at least t$ree yearsC and 7k8 7'8 gree to "ractice medicine only in HH2-designated s$ortage areas during t$is t$ree-year "eriod.E

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#oti(ication o( disci"linary action0termination? T$e :-1 "$ysician s$all noti(y t$e PC)5 in 9riting5 9it$in 34 days o( disci"linary action and0or termination. %n t$e e3ent o( any emergency termination due to circumstances bearing on t$e $ealt$ or sa(ety o( "atients or ot$er indi3iduals5 t$e PC) must be noti(ied no later t$an se3en days a(ter t$e emergency termination. Conditions leading to and conse&uences o( de(ault? =nderstand t$at a :-1 "$ysician is in de(ault i(5 at any time5 $e0s$e does not meet t$e conditions listed in t$is section. .iolations may result in t$e :-1 "$ysician and0or medical "ractice being dis&uali(ied (or re(erral or s"onsors$i". ny 3iolations o( t$e conditions o( state s"onsors$i" s$all be re"orted to PC) and to t$e =2C%2. :-1 "$ysician (ound in 3iolation o( t$ese conditions may $a3e $is0$er 3isa re3oked by =2C%25 and may be re&uired to return to $is or $er $ome country.

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Medical Practice Criteria and Policies To be eligible to em"loy a :-1 .isa Wai3er "$ysician5 a medical "ractice must7 1. 2$ortage designation re&uirement? He located in a (ederally designated Healt$ Pro(essional 2$ortage rea 7HP2 8 or (ederally designated +edically =nderser3ed rea or Po"ulation 7+= 0P85 and $a3e been o"erating at least si< mont$s be(ore re&uesting a :-1 .isa "$ysician. Ho9e3er5 a limited number o( slots are a3ailable (or sites located in non-designated areas. To see i( a site is located in a designated or undesignated area5 you may go to http://datawarehouse.hrsa.gov/GeoAdvisor/ShortageDesignationAdvisor.aspx. 2tatement o( need? 2ubmit a statement as to 9$y t$e :-1 "$ysician is needed at t$e site or in t$e community. Contract term0com"ensation? gree to em"loy t$e :-1 "$ysician (or no less or no more t$an t$e re&uired t$ree years at a market rate a""ro3ed by t$e =.2. De"artment o( Babor. !m"loyment agreements or contracts must incor"orate by re(erence t$e conditions o( :-1 .isa Wai3er s"onsors$i" "ro3ided in t$is document5 and must meet t$e conditions described in C 738 abo3e. greement to ser3e t$e underser3ed? cce"t all "atients regardless o( ability to "ay5 acce"t +edicaid and +edicare on assignment5 and use a sliding-(ee scale based on (ederal "o3erty guidelines to discount ser3ices to lo9-income uninsured "ersons. T$e +edical Practice must "ro3ide notice to t$e "ublic t$at suc$ a "olicy is in e((ect and a""ly t$ese access standards to t$e entire medical "ractice5 not sim"ly to t$ose "atients treated by t$e :-1 "$ysician. T$ese re&uirements s$ould be in "lace (or at least t$ree mont$s immediately "receding t$e re&uest (or 9ai3er. . Work-site documentation re&uirements? 2ubmit a se"arate site a""lication (or eac$ site at 9$ic$ t$e :-1 "$ysician 9ill be re&uired to 9ork. T$is 9ill include all "ractice sites as 9ell as $os"itals.

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nnual re"orting re&uirements? Re"ort annually5 in 9riting5 to t$e PC) on t$e status o( eac$ :-1 "$ysician5 utiliAation statistics (or t$e medical "ractice5 and any ot$er "ertinent in(ormation re&uested by t$e PC). 2am"le monitoring (orms are a3ailable on DH+H Web site at? *

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$tt"?00$sia.d$m$.maryland.go30o"ca02itePages0"co-md>13isa(orms.as"< #otice o( disci"linary action and0or termination? #oti(y t$e PC)5 in 9riting5 9it$in 34 days o( disci"linary action and0or termination o( t$e :-1 "$ysician. %n t$e e3ent o( any emergency termination due to circumstances bearing on t$e $ealt$ or sa(ety o( "atients or ot$er indi3iduals5 t$e PC) must be noti(ied5 no later t$an se3en days a(ter t$e emergency termination. Credentialing? ssume res"onsibility (or credentialing and (or &uality assurance o( :1 "$ysician a""licants. T$e PC) does not credential nor does it make any re"resentations concerning t$e &uali(ications or com"etency o( "$ysicians "laced under t$is "rogramC t$ese res"onsibilities rest solely 9it$ t$e s"onsor. +edical Practice 2u""lemental greement? 2ign an agreement 9it$ t$e PC) indicating t$at i(5 any time5 t$e PC) (inds t$e medical "ractice in de(ault o( t$is Policy5 3iolations may result in t$e medical "ractice and0or t$e :-1 "$ysician being dis&uali(ied (or re(erral or s"onsors$i" and 7i( a""licable8 any "resent :-1 "$ysician em"loyed by t$e medical "ractice may be trans(erred to anot$er eligible medical "ractice. .eri(ication o( Re"resentation greement? 2ign an agreement 9it$ t$e PC) indicating t$at t$e ttorney or Re"resentati3e em"loyed to com"lete t$e :-1 "$ysician6s a""lication is not a((iliated 9it$ t$e medical "ractice. Prior Recruitment !((ort? Pro3ide "roo( o( at least si<-mont$s recruitment e((orts 9it$in t$e last year 7does not $a3e to be continuous8 to recruit a =.2. citiAen or a "ermanent resident "$ysician. Recruitment0retention notices must be described5 and co"ies o( t$ese e((orts along 9it$ a com"re$ensi3e summary must be "ro3ided. statement o( di((iculty in recruiting =.2. citiAen "$ysicians is #)T su((icientC e3idence must include but is not limited to ne9s"a"er ad3ertisements5 national and 2tate medical >ournal announcements most likely to bring res"onses (rom &uali(ied5 a3ailable doctors5 and >ob o""ortunity notices "laced in medical sc$ools including all medical sc$ools in +aryland. %( e<ce"tional circumstances e<ist t$at "re3ented t$is recruitment5 detailed e<"lanations 9ill be considered and could reduce t$is re&uirement. !<ce"tional circumstances include5 but are not limited to t$e (ollo9ing? sudden loss o( a sole "ractitioner in a rural communityC t$e absence o( "$ysicians in a targeted s"ecialty 9$o 9ill acce"t +edical ssistance "atientsC small 7under 144 beds8 or rural $os"italsC loss o( more t$an *4 "ercent o( "ractitioners in a s"eci(ic s"ecialty in t$e county 9$ere t$e "ractice is located. 2ites can 3eri(y a circumstance outlined abo3e by "ro3iding a brie( summary describing in detail t$e recruitment "rocess. T$e =.2. De"artment o( 2tate 7D)28 is t$e (inal aut$ority in determining t$e ade&uacy o( t$e recruitment "rocess. T$ere(ore5 a""licants s$ould be "re"ared to "ro3ide documentation regarding recruitment e((orts to eit$er t$e PC) or D)25 i( re&uested. gree to com"ly 9it$ t$e "$ysician eligibility re&uirement listed in 2ection C o( t$is document. +onitoring? Hy signing t$is Policy5 agree to be monitored by t$e PC) on a "eriodic basis (or com"liance 9it$ t$is agreement and "ro3ide documentation in t$e (orm re&uired by t$e De"artment5 2tate and ;ederal Ba9. co"y o( t$e +aryland 2ite +onitoring ;orm is a3ailable on t$e DH+H Web site. Conditions leading to and conse&uences o( de(ault? =nderstand t$at a medical "ractice is considered in de(ault i(5 at any time5 t$e conditions listed in t$is section are ,

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not met. .iolations may result in t$e :-1 "$ysician and0or medical "ractice being dis&uali(ied (or re(erral or s"onsors$i". ny 3iolations o( t$e conditions o( s"onsors$i" s$all be re"orted to t$e =2C%2. medical "ractice (ound in 3iolation o( t$ese conditions is ineligible (or "lacement o( :-1 .isa Wai3er "$ysicians. 1*. #ote on PC) role in contracts? =nderstand t$at t$e PC) does not $a3e t$e aut$ority to mediate bet9een em"loyer and em"loyees "artici"ating in t$e :-1 "rogram5 to in3estigate allegations o( 9rongdoing (rom eit$er "arty5 or to en(orce labor standards. %( t$e PC) becomes a9are o( suc$ issues5 it 9ill recommend seeking ad3ice (rom an attorney or contacting t$e a""ro"riate agency 7i.e.5 +edicaid ;raud and buse5 De"artment o( Babor5 =nited 2tates CitiAens$i" and %mmigration 2er3ices8. ;urt$er5 t$e PC) assumes no res"onsibility (or negotiations or content o( em"loyment contracts or (or termination o( t$e contracts. 2ign a notariAed em"loyer attestation signi(ying t$at t$e medical "ractice $as not "aid a recruitment (ee to t$e PC) or a recruitment ser3ice (or em"loyment re(errals originating 9it$ t$e PC). Transfers Trans(ers? :-1 .isa Wai3er a""lication is a""ro3ed (or a s"eci(ic location5 and an em"loyer cannot "lace t$e :-1 "$ysician at anot$er address or sto" t$e :-1 "$ysician (rom 9orking at a site 9it$out (irst submitting a (ormal re&uest (or trans(er 9it$ t$e PC) and recei3ing a""ro3al (rom =2C%2. T$is rule a""lies e3en i( t$ere is no c$ange in em"loyer5 only c$ange in site7s8. +o3ement o( a :-1 "$ysician to a location t$at $as not been a""ro3ed by t$e PC) 9ill result in t$e :-1 "$ysician being in noncom"liance 9it$ t$e "rogram and may be re"orted as suc$ to =2C%2. T$e PC) "re(ers t$at trans(ers (rom one em"loyer to anot$er be a c$oice o( last resort. Ho9e3er5 i( circumstances 9arrant a trans(er5 it 9ill be recommended 9$en t$e a""ro"riate documentation $as been recei3ed. %( t$e PC) determines5 in its sole discretion5 t$at an em"loyer $as e<cessi3e trans(ers5 t$e em"loyer may not be eligible (or a "lacement in t$e ne<t (iscal year. :-1 "artici"ants 9is$ing to trans(er must submit t$e re&uired documents be(ore t$e trans(er 9ill take "lace. %( all necessary in(ormation is "ro3ided and (ound to be a""ro"riate5 t$e PC) 9ill send a letter o( su""ort (or trans(er to =2C%25 9it$ a co"y to "etitioner5 9it$in 34 days a(ter recei"t o( t$e re&uest. %( t$e :-1 "$ysician is unem"loyed (or a time during t$e trans(er5 t$at time 9ill not count to9ards t$e t$ree-year obligation.

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2. a. b. c.

Trans(erring (rom +aryland to T$e :-1 "$ysician must?

not$er 2tate?

#oti(y t$e PC)5 in 9riting5 o( t$e intent to trans(er5 detailing t$e reasons (or t$e trans(er. Pro3ide t$e com"lete name5 address5 and "$one number o( t$e ne9 em"loyer and date o( trans(er. T$e original em"loyer must? 718 Pro3ide a letter to t$e PC) releasing t$e :-1 "$ysician (rom em"loyment 9$ic$ e<"lains t$e reasons (or termination along 9it$ a com"leted :-1 .eri(ication o( !m"loyment (orm.

8ote7 %( t$e original em"loyer re(uses to release t$e :-1 "$ysician (rom t$e em"loyment contract and t$e :-1 "$ysician belie3es t$at t$e em"loyer is in 3iolation o( t$e em"loyment contract5 t$e :-1 "$ysician s$ould seek t$e ad3ice o( $is or $er o9n legal counsel about terminating t$e contract. T$e PC) 9ill not re3ie9 a trans(er re&uest 9it$out a letter o( release (rom t$e original em"loyer5 unless t$e contract $as been legally terminated. %( a :-1 "$ysician terminates t$e em"loyment contract 9it$out cause5 t$e em"loyer s$ould seek t$e ad3ice o( t$e em"loyer6s legal counsel. T$e PC) does not $a3e t$e aut$ority to determine legal grounds (or terminating an em"loyment contract. )! pplication Process To "rocess any a""lication5 t$e Re3ie9 ;ile and :-1 "$ysician6s last name must be included on eac$ "age o( a""lication5 and t$e De"artment o( Healt$ and +ental Hygiene6s 7DH+H8 )((ice o( Primary Care ccess6s Primary Care )((ice 7PC)85 must recei3e t$e (ollo9ing documents5 organiAed in t$e order listed? 1. Co3er Better (rom t$e em"loyer 9is$ing to $ire t$e :-1 "$ysician (or t$ree years5 stating? a. b. c. d. 9$y t$e "$ysician is needed5 all sites 9$ere t$e "$ysician 9ill 9ork5 t$at t$e "$ysician 9ill 9ork at minimum '4 $ours a 9eek 732 o( t$ose $ours must be in direct "atient care85 indicate 9$et$er eac$ site is in a (ederally designated s$ortage area or not 7indicate HP2 %D number and0or += %D number5 and0or i( t$e (acility5 t$e ;%P2 County Code and Census Track #o.8 $ome country o( t$e "$ysician5 :-1 3isa 9ai3er a""lication (ile case number o( t$e "$ysician5 ty"e o( "ro3ider5 and t$at t$e em"loyer acce"ts all "atients regardless o( ability to "ay.

e. (. g. $. 2.

Proo( o( at least si<-mont$6s e((orts by em"loyer 9it$in t$e last year 7does not $a3e to be continuous8 to recruit a =.2. citiAen or a "ermanent resident "$ysician. 72ee section D 7118 (or details.8

3. '. *. ,. -. /. 1. 14. 11. 12. 13. 1'.

n em"loyment agreement or contract bet9een t$e :-1 "$ysician and an eligible "ractice. 72ee section C 738 (or details.8 Co"ies o( all (orms D2-2411 7(ormerly % P-,,8. Com"leted Data 2$eet 7D2 343*8. :-1 P$ysician6s Curriculum .itae. Co"y o( all di"lomas. Co"y o( all academic transcri"ts. Co"y o( all P$ysician Bicenses. Co"y o( !ducational Commission (or +edical @raduates credentials. Co"y o( =.2. +edical Bicensing !<amination 2core Re"orts (or 2te"s 15 2 and 3. Betters o( Recommendation (or :-1 "$ysician. 2liding ;ee 2cale and 2liding ;ee 2cale Policy (or +edical Practice. :-1 2ite ""lication7s8 9it$ re&uired attac$ments. )ne a""lication (or e3ery site5 $os"ital or "ri3ate "ractice5 is needed 9$ere t$e :-1 "$ysician 9ill be re&uired to 9ork. :-1 .eri(ication o( Re"resentation K +edical Practice. :-1 .eri(ication o( Re"resentation K P$ysician. !m"loyer ttestation 7signed by President0C!) and notariAed8. !m"loyer !<c$ange ttestation 7signed and notariAe8. 2igned :-1 .isa Wai3er Policy re&uirements signi(ying agreement by t$e :-1 "$ysician5 medical "ractice and medical re"resentati3e. :-1 .isa0#ational %nterest Wai3er Programs .eri(ication o( !m"loyment. 2tatement o( #o ;inancial )bligation in Bieu o( #o )b>ection Better 7signed and notariAed8. ll ot$er (orms t$at are re&uired by t$e =.2. De"artment o( :ustice %mmigration and #aturaliAation 2er3ice. n original and one co"y o( t$e entire 9ai3er re&uest "ackage must be submitted. T$e :-1 3isa 9ai3er re3ie9 (ile number and a""licant6s last name 7make t$is t$e same as in %ntro to t$is section8 must be ty"ed on lo9er rig$t $and corner o( e3ery "age o( t$e re&uest "ackage and co"y o( t$e "ackage.

1*. 1,. 1-. 1/. 11. 24. 21. 22. 23.

*!

+etters of ,"pport for )ederal gency ,ponsorship %n t$ose instances 9$ere a (ederal agency re&uires a letter (rom t$e 2tate5 t$e 2tate 9ill only 9rite suc$ a letter (or t$ose situations t$at meet all o( t$e conditions described abo3e and $a3e com"leted t$eir ser3ice obligation.

DHMH9s sponsorship of a J-1 Visa Waiver applicant9s re:"est for a -aiver is contingent "pon the completion of all re:"ired and necessary national and international ed"cational5 employment5 criminal5 and national sec"rity bac$gro"nd chec$s of the pplicant by the #"rea" of Citi;enship and <mmigration ,ervices '=,C<,( and by any other federal agency or program charged -ith cond"cting sec"rity chec$s on foreign nationals and>or resident aliens 1

in the =nited ,tates! ,ponsorship of an applicant9s re:"est for a J-1 Visa Waiver sho"ld not be constr"ed as a certification5 endorsement5 or -aiver by the PC2 of any sec"rity proced"res and bac$gro"nd investigations that are re:"ired or necessary and that may have been cond"cted by the =,C<, or any other federal agency responsible for a"thori;ing the applicant to enter5 reside5 and -or$ in the =nited ,tates on any basis! < have read5 "nderstand and agree to the foregoing terms! < f"rther "nderstand that fail"re to comply -ith these re:"irements may res"lt in denial or loss of J-1 Visa -aiver stat"s! J-1 Visa Waiver pplicant Physician7 Physician ,ignat"re7??????????????????????????????????????Date7????????????????? Physician 8ame7??????????????????????????????????????????????????????????????? Medical Practice7 8ame7????????????????????????????????????????????????????????????????????????? "thori;ed Medical Practice @epresentative7 ,ignat"re7??????????????????????????????????????????????? Date7 ???????????????? 8ame7???????????????????????????????????????????????????????????????????????? Title7????????????????????????????????????????????????????????????????????????? H! ,tate Contact ll corres"ondence s$ould be directed to? C$ristina 2$aklee5 Work(orce Coordinator +aryland De"artment o( Healt$ and +ental Hygiene Healt$ 2ystems and %n(rastructure dministration +aryland Primary Care )((ice 241 West Preston 2treet5 Room 34, Haltimore5 +D 21241 P$one? '14--,--,*23 L ;a<? '14-333--*41 c$ristina.s$akleeMmaryland.go3
December 1111 Re3? +arc$ 2444 Re3? "ril 2441 Re3? +ay 2442 Re3? :anuary 2443 Re3? 2e"tember 2443 Re3? ;ebruary 244* Re3? +ay 244* Re3? ug. 244, Re3. )ctober 244/ Re3. )ctober 2441 Re3. "ril 2412 Re3. )ctober 2412 Re3. +ay 2413

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