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Guidelines for the Creation of a New Affiliation Agreement

  1. Regional campus will contact Medical Student Affairs via msaffil@iupui.edu to request the current template of the Clinical Affiliation Agreement and identify the hospital/institution with whom an affiliation is being sought.

  2. Hospital/Institution should consult with their legal department.

  3. If the hospital/institution legal department wants to make any changes to the template, they should contact John Keller and Melissa Titus (msaffil@iupui.edu) at IUSM for further assistance.  Note: changes made to the template will slow the approval process by several weeks. 

  4. Once final language is approved, the hospital/institution should sign three (3) copies and return to John Keller (msaffil@iupui.edu) at IUSM.

  5. IUSM will route the document for official signatures and return an original to theregional campus and to the hospital/institution.

  6. IUSM will monitor expiration dates and contact hospitals/institutions when updates are required.