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

Orientation sessions are held over three days between 8:00am-5:00pm. Schedule breakdown depends on specialty area. Note some sessions take place on Tuesday-Thursday. Most take place Monday-Wednesday. Due to Epic downtime, the last session in December 2023 will be held December 18-19 and 21. Please select one of the following sessions:

October 2-4, 2023

October 16-18, 2023

November 6-8, 2023

November 20-22, 2023

December 4-6, 2023

December 18-21, 2023

January 2-4, 2024

January 16-18, 2024

February 5-7, 2024

February 19-21, 2024

March 4-6, 2024

March 18-20, 2024

April 1-3, 2024

April 29-1, 2024

May 13-15, 2024

May 28-30, 2024

June 10-12, 2024

June 24-26, 2024

July 1-3, 2024

July 8-10, 2024

July 22-24, 2024

August 5-7, 2024

August 19-21, 2024

September 2-4, 2024

September 16-18, 2024

September 30-2, 2024

October 14-16, 2024

October 28-30, 2024

November 11-13, 2024

November 25-27, 2024

December 9-11, 2024

UK HealthCare New Provider Orientation Registration

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