Va Form 10-0094a - Medical Education Affiliation Agreement Between Department Of Veterans Affairs (Va), And Institutions Sponsoring Graduate Medical Education And Their Affiliated School Of Medicine

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MEDICAL EDUCATION AFFILIATION AGREEMENT
BETWEEN DEPARTMENT OF VETERANS AFFAIRS (VA),
AND INSTITUTIONS SPONSORING GRADUATE MEDICAL EDUCATION AND
THEIR AFFILIATED SCHOOL OF MEDICINE
Use when trainees are enrolled in an academic program accredited by the Liaison Committee for
Medical Education (LCME) or the Accreditation Council for Graduate Medical Education (ACGME)
VA NETWORK
VA MEDICAL CARE FACILITY (including city and state)
SPONSORING INSTITUTION (including ACGME ID number, city and state)
AFFILIATED PARTICIPATING INSTITUTION (including ACGME ID number, city and state)
AFFILIATED SCHOOL OF MEDICINE (including city and state)
This agreement, when duly executed and approved by the Department of Veterans Affairs (VA), establishes
an affiliation between VA, its Veterans Integrated Service Networks, and the listed VA facilities, and the
institution sponsoring graduate medical education, its affiliated participating institutions and their affiliated school
of medicine for the academic purposes of enhanced patient care, education, and research. A sponsoring institution,
its affiliated participating institutions and their affiliated school of medicine that are signatories to this document
are collectively referred to as “affiliated institutions” or “the affiliate”. All parties to the agreement have a shared
responsibility for the academic enterprise. The affiliated institutions accept primary responsibility for the
integrated education programs conducted with VA while VA retains full responsibility for the care of VA patients
and administration of its health care system. Additional responsibilities are delineated below.
BACKGROUND
The provision of education for future health care providers and the conduct of research are VA statutory
missions. By virtue of the close relationships between VA and the nation’s academic institutions, VA plays a
leadership role in reshaping the education of future health care professionals to help meet the complex scope of
the nation’s health care delivery system. It is the intent of VA to maintain its long-standing practice of effective
VA FORM 10-0094a
September 2014
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