Request for Internal Medicine Internship and Residency Postgraduate Training Verification, ACGME Program# 1401121099

Fee Notification

$100.00 for each form.

Requests will only be processed with payment and must include: Full name at the time of training, date of birth, and with an original/wet or notarized digital signature authorization. A DocuSign release/consent is also acceptable.

Please call (904) 244-3500 for payment and reference account# 16014 for internal medicine residency training verification. Please forward the email receipt along with the forms to be filled out to lorna.matos@ufhealth.org.

Please allow 5-10 business days for completion.