UK HealthCare New Provider Orientation Registration

Please be sure to complete the provider orientation registration form in its entirety as the information will also be used for badge printing purposes. If you have any questions, please feel free to contact Enterprise Learning, 859-257-9226.

Your name *

Your email address *

Your phone number *

Provider Information

Provider first name *

Provider middle name

Provider last name *

Provider email *

LinkBlue ID

UK employee ID number

NPI Number

Provider cellphone number *

Title *

Degree *

Division/section name *

Department name *

Will this provider see patients in an outpatient clinic?

Yes

Will this provider see patients in the hospital?

Yes

Has this provider been a UKHC employee in the past? If yes, please provide date of departure and provider's role at the time (e.g. resident, APRN, etc.).

Yes

If yes, please provide date of departure and provider’s role at the time (e.g., Resident, Fellow, R.N.).

Date of departure

Month

Day

Year

Has this provider been a UKHC employee in the past (including Good Samaritan, Chandler, etc.)?

Yes

Cost Center Number *

FTE *

Start date

Month

Day

Year

Additional comments

Please include any additional information here.

Does the provider have any dietary restrictions?
Does the provider already have an ID Badge? If so, is it correct for their new position?

Comment

Choose an orientation session

The schedule for orientation sessions is as follows:

Monday, 8 a.m to 4 p.m.
Tuesday, 8 a.m. to 4 p.m.
Wednesday, 8 a.m. to 4:30 p.m.

Please note that the June 20, August 1, and September 5th sessions take place on Tuesday-Thursday and the July 5-7 session takes place on Wednesday-Friday. Times will remain the same.

Please select one of the following sessions

June 20-22

July 5-7

July 17-19

July 24-26

August 1-3

August 14-16

August 21-23

August 28-30

September 5-7

September 18-20

October 2-4

October 16-18

November 6-8

November 20-22

December 4-6

December 18-20

UK HealthCare New Provider Orientation Registration

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