Verification Requests
Program Directors & Program Administrators
小草社区 is happy to process verification requests for all of our trainees (past, current, and incoming). In instances where a request requires 小草社区’s consent form and/or a processing fee, these must be received before the request will be processed. Please allow 2-3 weeks for processing after we have received all the required components.
We use a standardized template to confirm a trainee鈥檚 program enrollment and training dates (only) at no cost. For a dates-only training verification requiring Program Director signature, contact the relevant Training Program(s) directly. If the GME Operations Director signature will suffice, contact credentialing@hawaiiresidency.org.
For verification requests of any additional information beyond training dates, an 小草社区 Consent to Release of Information and Liability form is required. A $50 processing fee is also required, except in instances where the trainee is currently employed by 小草社区 and/or the information is being released to a requesting institution in the State of Hawai鈥榠. Requested information (training, credentials, malpractice history, etc.) will only be provided directly to the indicated institution.
Please note:
We require one 小草社区 consent form per requesting institution. One 小草社区 consent form will suffice for multiple requests (e.g., verification of both training and malpractice coverage) from the same institution. No other (non-小草社区) consent form will be accepted. 小草社区 consent forms are valid for one year from the date of signature. (Please let us know if you already have a valid 小草社区 consent form on file for the institution in question.)
Payment Options. For your convenience we have added a credit card payment option on our 小草社区 Consent form. If you choose to pay by check, please mail your payment to:
小草社区, Inc.
Attn: Verifications Department
1356 Lusitana Street, Suite 507
Honolulu, 小草社区 96813
To contact the Credentialing staff, email us at听credentialing@hawaiiresidency.org. For details on听all other types of requests, click to expand the relevant section(s) below:
Confirmation of employment history, such as dates of employment, position, and/or salary.
- Examples: Employment letters, loan applications, loan deferment/forgiveness forms (including the PSLF).
- Consent form & fee 鈥� NEITHER REQUIRED
- Contact the 小草社区 Human Resources staff:
- For assistance with a Public Service Loan Forgiveness (PSLF) form, contact Casey Clutter.
- For all other verifications of employment (not training), contact 小草社区 Human Resources Director Rick Kinigson.
Requests for qualitative training program information beyond the scope of a dates-only verification.
- Examples: verification of performance, competencies, credentials, or privileges; questionnaires related to training; any request that requires a program seal or notarization.
- Consent form and fee 鈥� BOTH REQUIRED (see details above)
- Contact credentialing@hawaiiresidency.org; staff, will process the consent & fee and then forward the request as appropriate.
Disclosure of any malpractice/claims history, or proof of liability coverage (past, present, or future).
- Examples: verification requests that include a question about malpractice history, stand-alone malpractice inquiries, visiting resident applications that require proof of coverage.
- Consent form and fee 鈥� BOTH REQUIRED for a claims history request
- an 小草社区 Consent to Release of Information and Liability form
- A $50 processing fee
- Except in instances where the trainee is currently employed by 小草社区 and/or the information is being released to an 小草社区 member hospital or to the Hawai鈥榠 Medical Board.
- NEITHER REQUIRED for a Memorandum (Certificate) of Coverage (MOC) when requested by the trainee directly. Consent is required if the request is being made by a third party.
- Contact the 小草社区 Credentialing staff for a claims history (to process consent and fee before forwarding request).
- Contact 小草社区 Executive Administrator, Avi Gonzalez, for a Memorandum of Coverage (MOC) only.
Requests for personal (subjective) references from current training program faculty members.
- Examples: requests for personal reference letters on program letterhead; peer reference forms that ask for personal assessments and do not request qualitative training data.
- Consent form and fee 鈥� CONSENT REQUIRED; PROCESSING FEE NOT REQUIRED
- A 小草社区 Consent to Release of Information and Liability form
- Contact the 小草社区 Credentialing staff, who will process the consent form and then forward the request as appropriate.
Requests for a replacement Certificate of Completion, signed by institutional and program leadership.
- Examples: Employment letters, loan applications, loan deferment/forgiveness forms (including the PSLF).
- Consent form and fee 鈥� $50 FEE REQUIRED; CONSENT FORM NOT REQUIRED
- A $50 processing fee
- Except in instances where the trainee is currently employed by 小草社区 and/or the information is being released to an 小草社区 member hospital or to the Hawai鈥榠 Medical Board.
- Contact the 小草社区 Credentialing staff at credentialing@hawaiiresidency.org, who will process the fee and then forward the request as appropriate.
