GP registrar availability to assist with Hospital Surge Plans (COVID-19)

Registration

Thank you for completing this EOI for hospital surge workforce planning. Your details will be forwarded to NSW/ACT Health. If your availability matches a hospital need you will be contacted directly.

Please note, GP Synergy supports registrars working in hospital environments during the COVID-19 pandemic, however, we are unable to guarantee this work will count towards GP training. If you wish this work to be counted towards GP training please discuss this with your medical educator prior to accepting a position to determine if this is a suitable GP training environment.

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* 1. Please complete the details below:

First name:

Last name:

Email:

Best contact phone number:

Registration number:

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* 2. Current Working with Children (WWC) check or Working with Vulnerable People check?

Yes

Date of expiry (DD/MM/YYYY)

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* 3. Preferred location to assist COVID-19?

Town/City

State

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* 4. Postgraduate year

PGY3

PGY4

PGY5

PGY6

PGY7

Other (please specify)

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* 5. Last Hospital rotation

Hospital (please include name and country) e.g. The Canberra Hospital, Australia

Discipline

Date

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* 6. Please advise on your availability to assist with Hospital Surge Plans:

Current Working Location (list as many as applicable)

Special Interest Area (other than GP)

Former Specialty (if applicable)

How many days, which days and what hours are you available to work?

When would you be available to start? (DD/MM/YYYY)