PGY-1 Practice Residency



Similar documents
University of Puerto Rico School of Pharmacy and Walgreens Community Pharmacy Residency Program (PGY1), San Juan, Puerto Rico

Philosophy: General Description: Program Goals:

Residency Preceptor Biographies *indicates member of the Residency Advisory Council

PGY2 Hospice and Palliative Care Residency Program. Information Packet

PGY1 Pharmacy Residency Preceptor Bios

Overview. What is Clinical Pharmacy. ACCP: History and Background. ACCP: History and Background. Where Do ACCP Members Practice?

Kelly C. Lee, Pharm.D., MAS, BCPP

Christopher Betz, Pharm.D., BCPS

Elective Experiences Roosevelt University Teaching Certificate

Residency Program Faculty Biographies

8/10/2010. Residency Insights: Getting the inside scoop. Scoop: being the optimal candidate. Scoop: finding the right program for you

University of Louisville Hospital PGY1 Pharmacy Residency Program Summary

Pharmacy Practice Residency Preceptors

Briefing Paper for the ASHP Ambulatory Care Conference and Summit, March 3-4, 2014, Dallas, Texas

VA St. Louis Residency Preceptors

Professor, Pharmacy Practice, Ohio Northern University, College of Pharmacy Business Law

COVER LETTERS. In general, a cover letter should represent your personal style while maintaining a business like format.

Preceptors. Paula Moyers, PharmD, BCPS / Pharmacy Residency Program Director

ACROSS THE CONTINUUM: Optimizing Strategies for Acute to Chronic Pain Management HEALTH-SYSTEM PHARMACIST PERSPECTIVES AGENDA

UHealth Pharmacy Mission & Vision

Orlando VA Medical Center s Pharmacy Residency Program Preceptor Profiles

PRECEPTOR INFORMATION (BIO)

Graduate Education in Pharmacy Schools: Pharmacy Administration

Pharmacy Residency Programs St. Louis Children s Hospital StLouisChildrens.org

Advancing Pharmacy Practice via Privileging and Credentialing

WRITING YOUR CURRICULUM VITAE

Clinical Preceptors. April Allen, PharmD, CACP. Lisa Chastain, PharmD

PHYSICIANS / SURGEONS

Oklahoma City, OK ODMHSAS Training Institute. McAlester, OK Eastern Oklahoma State College Wanda Bass Building - Room 111

Our Team Published on CMSA ( Kyle E. Hultgren, PharmD. Director, Center for Medication Safety Advancement

Residency Accreditation Frequently Asked Questions

PGY-2 ONCOLOGY PHARMACY RESIDENCY

YOUR TALENT SEARCH, SIMPLIFIED

ASHP Accredited PGY1 & PGY2 Residency with Master s Degree in Health-System Pharmacy Administration

Brigham and Women s Hospital PGY-2 Critical Care Pharmacy Residency

The University of Cincinnati is an affirmative action/equal opportunity employer.

Dana G. Carroll, Pharm.D., BCPS, CDE Clinical Associate Professor Auburn University Harrison School of Pharmacy Auburn, Alabama

Saint Francis Medical Center College of Nursing Peoria, Illinois. Doctor of Nursing Practice. Application for Admission

Bradford W. Schwarz, MS, PA-C. Mandy Jones, PharmD, PA-C, BCPS

Northeast Ohio Medical University (NEOMED) Chair of Pharmaceutical Sciences Search

PGY-1 PHARMACY RESIDENCY

Clinical Operations Manager Residency Program Director Kaiser Permanente Medical Care Program, Santa Clara

ALEXIS ANDERSON 280 Calhoun Street MSC 132, Charleston, SC 29425

Jesse Brown VA Medical Center 820 South Damen Ave. Chicago Illinois 60612

Programme Name: Post-Baccalaureate Doctor of Pharmacy (Pharm. D) Programme Code: PPHPHARPT

MCPHS University and Pfizer. Biopharmaceutical Industry Fellowship Program

MASTER OF ARTS IN CLINICAL PSYCHOLOGY

Postgraduate Year Two (PGY2) Health System Pharmacy Administration Residency SETTING Ambulatory Care: Education and Training: PHARMACY SERVICES

Tampa General Hospital s Pharmacy Residency Program

Research Opportunities

COMPASSIONATE NURSING CARE

Board of Pharmaceutical Specialties. Todd Canada, PharmD, BCNSP, FASHP, FTSHP University of Texas MD Anderson Cancer Center

Clinical Headquarters. Cardiologist CV. Vaughn W. Payne, PharmD, MD, MBA, FACP, FACC, CCDS, CPE. States Covered: KY, IN

AMERICAN BOARD OF PROFESSIONAL PSYCHOLOGY, INC. APPLICATION FOR SPECIALTY CERTIFICATION IN SCHOOL PSYCHOLOGY

Western Missouri Psychiatric Pharmacy Residency Program

Doctor of Pharmacy/Master of Public Health Joint Degree Program

Tampa General Hospital's Pharmacy Residency Program

Pharmacy Education: Professional and Graduate Programs

NCAP Board of Directors President-Elect

[ Residents ]

LEARN, DO, TEACH utoledo.edu/pharmacy/residency

PA CME Requirements. Alaska Alaska Physician Assistants must maintain an active NCCPA certification for license renewal.

Physician Assistant Program Master of Medical Science (MMS)

Monash University - Master of Clinical Pharmacy

Graduate Programs in. Higher Education

September Dear Applicant:

Master of Science in Nursing

How To Become A Veteran Pharmacy Technician

PharmD Postdoctoral Fellowship Program

CADC Degree Program Overviews

CLINICAL PRIVILEGE WHITE PAPER Psychology

Doctor of Pharmacy/Master of Public Health Joint Degree Program

Effective and Compliant Utilization of Nurse Practitioners and Physician Assistants

DOCTORAL PROGRAM ADMISSIONS OFFICE 1255 Amsterdam Avenue, Room 919 New York, NY Telephone: (212)

How To Change The Board Certification Process

AZZAH S. ZAIDI PROFESSIONAL PROFILE AREAS OF EXPERTISE PROFESSIONAL EXPERIENCE

APPLICATION INSTRUCTIONS

Approval for Pharm.D./Masters in Public Health (MPH) Dual Degree Program

Combined Masters in Nutrition/Dietetic Internship Program

UIC. GRADUATE COLLEGE (M/C 192) 601 S. Morgan, Room 606 Chicago, Illinois INSTRUCTIONS FOR GRADUATE APPOINTMENTS

B.S. in Nutrition and Exercise Physiology WSU Spokane. Application for Fall Admission

MICHAEL BIGLOW 1518 BEDFORD AVE APT 2L BROOKLYN, NY PHONE Georgia Institute of Technology

NEW ASHP PGY-1 ACCREDITATION STANDARD

Tampa General Hospital's Pharmacy Residency Program

DOCTOR OF PHARMACY PROGRAM

Accreditation and Quality Assurance

Diversity Student Summer Research Opportunity Program. June 6, 2014 August 1, 2014 PROGRAM DESCRIPTION

Transcription:

PGY-1 Practice Residency

The purpose The of purpose St. Elizabeth s of St. Elizabeth s Residency Residency Program is Program to prepare is to the prepare PGY1 the resident PGY1 as an integral resident member as of an the integral health member care team of the capable health care of delivering team capable pharmaceutical of care to patients delivering in several pharmaceutical specialized care areas. to patients in several specialized areas.. The Residency Central to the St. Elizabeth s non-traditional program is the flexibility the resident has in selecting from more than ten electives, each designed to meet their interests as they progress through the residency. Active participation in hospital committees, completion of a residency project, presentation at a regional conference and publication of the research are fundamental components designed to enhance project management skills while improving patient care. Required learning experiences include: Orientation/Operational Pharmacy Practice Internal Medicine Advanced Internal Medicine Drug Information Ambulatory care Medication Safety Administration Many electives are offered throughout the St. Louis metro area with the Clinical Faculty of Southern Illinois University Edwardsville (SIUE) School of Pharmacy. However, each resident is encouraged to identify opportunities which meet the ASHP requirements and provide a comprehensive educational experience. Elective learning experiences include cardiology, infectious disease, psychiatry, pain and palliative care, informatics, teaching, pediatrics, oncology, and emergency medicine. Others are available based on the residents individual interests. Throughout the rotation the residents are expected to mentor pharmacy students and provide instruction to the staff and medical residents. To enhance the resident s didactic opportunities a Teaching Elective and Certificate are offered through the SIUE School of Pharmacy. The ASHP accredited 12-month PGY-1 residency offers a breadth of rotation experiences unparalleled in the region. Currently there are two PGY-1 residency positions available. Though affiliation with Southern Illinois University Edwardsville School of Pharmacy, more than fifteen different clinical rotations are available.

The St. Elizabeth s Hospital PGY-1 Practice Residency is affiliated with the Southern Illinois University Edwardsville (SIUE) School of Pharmacy. Our residents receive faculty appointments within the Department of Pharmacy Practice and have a widerange of interest-dependent teaching opportunities. Teaching Certificate In collaboration with the SIUE School of Pharmacy, the St. Elizabeth pharmacy resident will have the opportunity to earn a teaching certificate through a hybrid, web-based learning platform. Self-directed learning modules guide the resident through important concepts in preparation for delivery of formal didactic lectures, small-group facilitation, precepting of students, and assessment. The Hospital Established in 1875, St. Elizabeth s Hospital is an affiliate of the Hospital Sisters Health System. St. Elizabeth s Hospital serves the Southern Illinois-St. Louis metropolitan area with over 40 medical specialties and a broad range of services, from a SCPC accredited Chest Pain Center to a Level II+ Special Care nursery. As a community teaching hospital, St. Elizabeth s is home to the St. Louis University School of Medicine Family Medicine Residency Program. The Pharmacy Through state-of-the-art technologies including electronic medical records and intervention documentation, the resident is able to provide comprehensive pharmaceutical care. Bedside bar-coding at the point-ofcare, computerized prescriber order entry and smart pump technology are examples of pharmacy activities in advancing patient care and safety. Belleville, Illinois Belleville, French for beautiful city, is a perfect blend of small town living and proximity to a major metropolitan area. Belleville was one of 10 cities nationwide to receive the All-American City Award for sustained community improvements in 2011, and a frequent recipient of the Governor s Hometown Award. St. Louis, Missouri Greater St. Louis consistently ranks as one of the top places to live in the U.S. As a suburb of St. Louis, Belleville is located only minutes from worldclass cultural institutions, a wide range of arts and entertainment, and an abundance of outdoor recreational activities.

Preceptors Julia Brian Schimmelpfennig, Thompson, RPh, MBA PharmD, MS, BCPS, CDE Julia Brian Schimmelpfennig Thompson is the is the Director Clinical of Manager Pharmacy and Residency Services at Program St. Elizabeth s Director at Hospital. St. Elizabeth s He received Hospital. his Bachelor Dr. Schimmelpfennig of Science degree received from the her St. B.S. Louis and College doctor of of pharmacy Pharmacy from and the his St. Master Louis in College Business of Pharmacy Administration and a from Masters Colorado of Science State in University. Clinical Pharmacology He serves as the from preceptor the University for the of residency Kentucky management College of Pharmacy. learning Subsequently experience. she completed a Pharmacy Practice Residency at the University of Louisville. She serves as the preceptor for the internal medicine residency rotations. Chris Julia Schimmelpfennig, Herndon, PharmD, PharmD, BCPS, CPE, MS, BCPS, FASHPCDE Julia Schimmelpfennig is the Clinical Manager and Residency Program Director Chris Herndon, PharmD, BCPS, CPE, FASHP is the Residency Program at St. Elizabeth s Hospital. Dr. Schimmelpfennig received her B.S. and doctor of Coordinator and an Associate Professor with the Southern Illinois University pharmacy from the St. Louis College of Pharmacy and a Masters of Science in Edwardsville (SIUE) School of Pharmacy and Clinical Assistant Professor Clinical Pharmacology from the University of Kentucky College of Pharmacy. with the St. Louis University School of Medicine. His practice is with the St. Subsequently she completed a Pharmacy Practice Residency at the University Louis University Family Medicine Residency Program where he leads the of Louisville. She serves as the preceptor for the internal medicine residency interdisciplinary chronic pain management service. Dr. Herndon offers an rotations. ambulatory care pain chronic pain care experience and is the co-director for the teaching certificate. Chris Herndon, PharmD, BCPS, CPE, FASHP Jing Chris Fan, Herndon, PharmD, PharmD, BCPS BCPS, CPE, FASHP is the Residency Program Coordinator and an Associate Professor with the Southern Illinois University Jing Edwardsville Fan is a (SIUE) Clinical School Associate of Pharmacy Professor and in Clinical the Department Assistant Professor Pharmacy with Practice the St. Louis at SIUE. University Dr. Fan School received of Medicine. her Doctor His of Pharmacy practice is from with the the University St. Louis of University Illinois at Family Chicago Medicine and subsequently Residency Program completed where a pharmacy he leads practice the residency interdisciplinary at the University chronic pain of Kentucky. management In addition service. to her Dr. faculty Herndon appointment offers an at ambulatory SIUE, Dr. care Fan pain also chronic provides pain clinical care services experience in cardiology and is the co-director at Mercy Medical for the Center. teaching Dr. certificate. Fan precepts the cardiology residency learning component. Jing Fan, PharmD, BCPS Jessica Kerr, PharmD, CDE Jing Fan is a Clinical Associate Professor in the Department of Pharmacy Practice at SIUE. Dr. Fan received her Doctor of Pharmacy from the University Jessica Kerr, Associate Professor, joined the SIUE School of Pharmacy of Illinois at Chicago and subsequently completed a pharmacy practice from the University of South Carolina College of Pharmacy. Dr. Kerr is a residency at the University of Kentucky. In addition to her faculty appointment at graduate of the St. Louis College of Pharmacy, where she earned both her SIUE, Dr. Fan also provides clinical services in cardiology at Mercy Medical B.S. and doctorate in pharmacy. She trained at Texas Tech University Health Center. Dr. Fan precepts the cardiology residency learning component. Sciences Center in Amarillo, Texas, where she specialized in primary care. Her current practice site is in coordination with the Veterans Affairs Medical Center Jessica Belleville Kerr, PharmD, outpatient CDE clinic. She precepts the ambulatory care residency learning experience. Jessica Kerr, Associate Professor, joined the SIUE School of Pharmacy from the Erin University Behnen, of South PharmD, Carolina BCPS College of Pharmacy. Dr. Kerr is a graduate of the St. Louis College of Pharmacy, where she earned both her B.S. and doctorate in Erin pharmacy. Behnen She is Director trained at of the Texas SIUE Tech Drug University Information Health and Sciences Wellness Center Center in and Amarillo, is an Texas, Associate where Professor she specialized in the in Pharmacy primary care. Practice Her current Department. practice She site received is in coordination her B.S. with and the Doctor Veterans of Pharmacy Affairs Medical degrees Center from St. Belleville Louis College outpatient of Pharmacy. clinic. She precepts Dr. Behnen the ambulatory completed care a drug residency information learning specialty experience. residency at The University of Tennessee in Memphis. Dr. Behnen co-precepts the drug information residency learning component..

Preceptors Michael Randazzo, PharmD Erin Behnen, PharmD, BCPS Erin Michael Behnen Randazzo is Director is a of Clinical the SIUE Pharmacy Drug Information Specialist and in Emergency Wellness Center Medicine and is an for Associate St Elizabeth s Professor Hospital. in the Dr. Pharmacy Randazzo Practice is a graduate Department. of St. She Louis received College her B.S. of Pharmacy and Doctor where of Pharmacy he earned degrees his B.S. from and St. Doctor Louis College of Pharmacy of Pharmacy. degrees. Dr. Behnen Afterwards completed he completed a drug a information Pharmacy specialty Practice Residency residency at The St. Elizabeth s University of Tennessee Hospital. He in is Memphis. the Pharmacy Dr. Behnen Practice co-precepts preceptor for the the drug Medication information Safety residency and learning Emergency component. Medicine residency experiences. Michael Randazzo, PharmD Michael Kelly Gable, Randazzo PharmD, is a Clinical BCPPPharmacy Specialist in Emergency Medicine for St Elizabeth s Hospital. Dr. Randazzo is a graduate of St. Louis College of Pharmacy where Kelly Gable he earned is an Assistant his B.S. Professor and Doctor in the of Department Pharmacy of degrees. Pharmacy Afterwards Practice. he completed Dr. Gable is a Pharmacy a graduate Practice of the University Residency of at Mississippi, St. Elizabeth s School Hospital. of Pharmacy, He is the Pharmacy and completed Practice a specialty preceptor residency for the Medication in Psychiatric Safety Pharmacy and Emergency Practice Medicine at the residency University experiences. of Southern California. Her clinical appointment is with Community Alternatives in St. Louis Missouri where she precepts the psychiatry residency Kelly learning Gable, experience. PharmD, BCPP Kelly Gable is an Assistant Professor in the Department of Pharmacy Practice. Dr. Gable is a graduate of the University of Mississippi, School of Pharmacy, and completed a specialty residency in Psychiatric Pharmacy Practice at the University Keith Hecht, PharmD, BCOP of Southern California. Her clinical appointment is with Community Alternatives in St. Louis Missouri where she precepts the psychiatry residency learning Keith Hecht is a Clinical Associate Professor in the Department of Pharmacy experience. Practice. Dr. Hecht received his B.S. and Doctor of Pharmacy from St. Louis College of Pharmacy. Subsequently, he completed a pharmacy practice Keith Hecht, PharmD, BCOP residency and an oncology specialty residency at the University of Kentucky Keith Chandler Hecht Medical is a Clinical Center. Associate His clinical Professor site is at Mercy in the Medical Department Center of where Pharmacy he Practice. precepts the Dr. oncology Hecht received residency his learning B.S. and experience. Doctor of Pharmacy from St. Louis College of Pharmacy. Subsequently, he completed a pharmacy practice residency and an oncology specialty residency at the University of Kentucky Chandler Medical Center. His clinical site is at Mercy Medical Center where he precepts the McKenzie Ferguson, PharmD, BCPS oncology residency learning experience. McKenzie Ferguson is Assistant Professor, Pharmacy Practice and practices McKenzie Ferguson, PharmD, BCPS in the Drug Information and Wellness Center. Dr. Ferguson received her B.A. McKenzie from Carthage Ferguson College is Assistant and her Professor, Doctor of Pharmacy Practice degree and from practices St. Louis in the Drug College Information of Pharmacy. and Wellness She completed Center. her Dr. pharmacy Ferguson practice received residency her B.A. from at Carthage SSM St. Mary s College Health and her Center. Doctor Dr. of Ferguson Pharmacy co-precepts degree from the St. drug Louis information College of Pharmacy. residency learning She completed experience. her pharmacy practice residency at SSM St. Mary s Health Center. Dr. Ferguson co-precepts the drug information residency learning experience. Scott Bergman, PharmD, BCPS Stacey Thacker, PharmD, BCPS, BC-ADM Scott Bergman is an Assistant Professor in the Department of Pharmacy Stacey Thacker is a Clinical Assistant Professor in the Department of Pharmacy Practice and holds a joint appointment with the Division of Infectious Diseases Practice with her clinic site at Scott Air Force Base. After receiving her doctorate at the Southern Illinois University School of Medicine in Springfield. After from St. Louis College of Pharmacy she completed her residency with an emphasis graduating from the College of Pharmacy at South Dakota State University, Dr. in ambulatory care and academia with the St. Louis College of Pharmacy and Bergman completed residencies in pharmacy practice and infectious disease North Central Community Health Center. Dr. Thacker is the coordinator of the SIUE at the West Virginia University Hospitals and School of Pharmacy. Dr. Bergman Teaching Certificate and precepts the ambulatory care component. is the preceptor for the adult infectious disease residency learning experience.

Preceptors Josh Schmees, PharmD Josh Schmees, PharmD Josh Schmees is the HSHS Southern Illinois Division System Pharmacist of Informatics and Automation Josh Schmees Services. is the Dr. Schmees HSHS Southern received Illinois his Doctor Division of Pharmacy System Pharmacist from the Ohio of Northern Informatics University- and Raabe Automation College of Services. Pharmacy. Dr. Prior Schmees to joining received HSHS, his Dr. Doctor Schmees of served Pharmacy as the St. from Elizabeth s the Ohio Pharmacy Northern University- Manager Raabe of Operations College of and Pharmacy. Technology. Prior Dr. Schmees to joining is the preceptor HSHS, Dr. for Schmees the informatics served as residency the St. Elizabeth s component. Pharmacy Manager of Operations and Technology. Dr. Schmees is the preceptor for the informatics residency component. Lisa Lubsch, PharmD, AE-C Lisa Lubsch Claudia is a Colombo, Clinical Assistant PharmD, BCPS Professor in the Pharmacy Practice Department and a Clinical Pharmacy Specialist at Cardinal Glennon Children s Medical Center. Dr. Lubsch received Claudia her B.S. Colombo and Doctor is a Clinical of Pharmacy Pharmacy degree Specialist from St. at Louis St. Elizabeth s College of Pharmacy Hospital. and completed Following a pediatric graduation specialty with her residency Doctor of at Pharmacy the Texas Tech degree University from St. Health Louis College Science Center of School Pharmacy, of Pharmacy. she completed Dr. Lubsch a PGY-1 precepts pharmacy the pediatric practice residency rotation. St. Vincent Hospitals in Indianapolis, Indiana and a PGY-2 Specialty Residency in Internal Medicine with the University of Texas-Austin. Dr. Colombo co-precepts the internal Jennifer medical Rosselli, residency PharmD, learning BCPS, experiences. BCACP Jennifer Rosselli is a Clinical Assistant Professor in the Department of Pharmacy Practice. Lisa After Lubsch, receiving PharmD, her B.S. AE-C and Doctor of Pharmacy degree from St. Louis College of Pharmacy she practiced in community pharmacy setting. Dr. Rosselli completed her pharmacy Lisa practice Lubsch residency is a Clinical at St. Elizabeth s Assistant Professor Hospital. Her in the ambulatory Pharmacy care Practice practice site is with Department the Southern and Illinois a Clinical Healthcare Pharmacy Foundation. Specialist Dr. at Cardinal Rosselli is Glennon a preceptor Children s for the ambulatory Medical care Center. residency Dr. learning Lubsch experience. received her B.S. and Doctor of Pharmacy degree from St. Louis College of Pharmacy and completed a pediatric specialty residency Miranda at Nelson, the Texas PharmD Tech University Health Science Center School of Pharmacy. Dr. Lubsch precepts the pediatric residency rotation. Miranda Nelson is a Clinical Specialist in Pediatric Infectious Diseases at St. Louis Children s Hospital and Clinical Assistant Professor in the Department of Pharmacy Practice Jennifer at SIUE. Rosselli, Dr. Nelson PharmD, received BCPS, BCACP her Doctor of Pharmacy degree from Auburn University and completed a pediatric residency at St. Louis Children s Hospital. Dr. Nelson precepts Jennifer the pediatric Rosselli infectious is a Clinical disease Assistant residency Professor learning the experience. Department of Pharmacy Preceptors Practice. After receiving her B.S. and Doctor of Pharmacy degree from St. Louis College of Pharmacy she practiced in community pharmacy setting. Dr. Rosselli Dawn Dankenbring completed her pharmacy practice residency at St. Elizabeth s Hospital. Her ambulatory care practice site is with the Southern Illinois Healthcare Foundation. Dawn Dankenbring Dr. Rosselli is is a preceptor a Clinical for Pharmacy the ambulatory Specialist care in residency cardiology learning and critical experience. care at St. Elizabeth s Hospital. After receiving her undergraduate degree in molecular biology and chemistry from University of Illinois at Urbana-Champaign she earned her Doctor of Pharmacy Miranda degree Nelson, from PharmD Southern Illinois University Edwardsville School of Pharmacy. She went on to complete a PGY-1 Pharmacy Practice Residency at Saint Luke s Hospital in Kansas Miranda City, Missouri. Nelson a She Clinical currently Specialist serves in Pediatric as a preceptor Infectious for Internal Diseases Medicine at St. Louis and Advanced Children s Internal Hospital Medicine and rotations. Clinical Assistant Professor in the Department of Pharmacy Practice at SIUE. Dr. Nelson received her Doctor of Pharmacy degree Jagruti Patel from Auburn University and completed a pediatric residency at St. Louis Children s Hospital. Dr. Nelson precepts the pediatric infectious disease residency Jagruti Patel is a Clinical Pharmacy Specialist at St. Elizabeth s Hospital with focus in learning experience. antibiotic stewardship, inpatient pain and diabetes management. After receiving her Doctor of Pharmacy from Purdue University, College of Pharmacy, she completed her Pharmacy Practice Residency at St. Elizabeth s Hospital and SIUE College of Pharmacy. Dr. Patel is a preceptor for the Internal Medicine and Advanced Internal Medicine residency experiences.

PHARMACY PRACTICE (PGY-1) APPLICATION FORM ALL APPLICATION MATERIALS MUST BE RECEIVED BY JANUARY 6 TH. REFER TO REVERSE SIDE FOR REQUIREMENTS. NAME: PLEASE PRINT LAST, FIRST, MIDDLE INITIAL PLEASE INDICATE WHICH ADDRESS YOU WOULD LIKE CORRESPONDENCE TO BE SENT DURING THE APPLICATION PROCESS ( ). CURRENT ADDRESS STREET, APT # CITY, STATE, ZIP CODE PERMANENT ADDRESS (IF DIFFERENT FROM ABOVE) STREET, APT # CITY, STATE, ZIP CODE PRIMARY PHONE #: ALTERNATE PHONE #: E-MAIL ADDRESS: COLLEGE OF PHARMACY ATTENDED: GRADUATION DATE (ANTICIPATED): RECOMMENDATIONS THREE LETTERS OF RECOMMENDATION MUST BE COMPLETED BY INDIVIDUALS WHO CAN ATTEST TO YOUR PRACTICE ABILITIES AND APTITUDES. AT LEAST TWO OF THEM SHOULD BE FROM A HEALTHCARE PROFESSIONAL. INCLUSION OF THE ASHP RESIDENCY APPLICATION RECOMMENDATION REQUEST FORM MUST ACCOMPANY EACH LETTER. PLEASE LIST THE NAMES, TITLES, AND ADDRESSES FROM WHOM WE SHOULD EXPECT TO RECEIVE LETTERS. 1. 2. 3. ARE YOU PREVENTED FROM BECOMING LAWFULLY EMPLOYED IN THE UNITED STATES BECAUSE OF VISA OR IMMIGRATION STATUS? IF YOU ARE APPOINTED TO THE RESIDENCY PROGRAM, YOU WILL NEED TO SHOW DOCUMENTATION PROVIDING IDENTITY INFORMATION AND EMPLOYMENT AUTHORIZATION FOR THE ENTIRE PERIOD OF THE RESIDENCY. I CERTIFY THAT THE INFORMATION SUBMITTED IN THIS APPLICATION IS COMPLETE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. I GRANT ST. ELIZABETH S HOSPITAL PERMISSION TO REQUEST ADDITIONAL INFORMATION, IF NECESSARY, FROM PREVIOUS SCHOOLS AND EMPLOYERS CONCERNING MY ACADEMIC RECORDS AND PROFESSIONAL ABILITY. SIGNATURE: DATE:

Application Requirement Checklist: Application form, letter of intent and CV Official College Transcripts Three letters of recommendation each accompanied with the ASHP Residency Application Recommendation Request Form Application, letter of intent, CV, college transcripts, three letters of reference each with an ASHP Residency Application Recommendation Request Form must be received by January 6 th. The letter of intent, stating career goals, major areas of interest, and reasons for applying to this program must be attached to your application form. SEND APPLICATION MATERIALS TO: Julia Schimmelpfennig, PharmD, MS, BCPS, CDE PGY-1 Residency Director Department of Pharmacy St. Elizabeth s Hospital 211 South Third Street Belleville, Illinois 62220 Julia.Schimmelpfennig@hshs.org INQUIRIES CONTACT: Julia Schimmelpfennig at 618-234-2120, ext. 2426 or Julia.Schimmelpfennig@hshs.org

American Society of Health-System Pharmacists Residency Applicant Recommendation Request Form Request for Recommendation by Applicant to Pharmacy Residency Program at St. Elizabeth s Hospital, Belleville, Illinois To be completed by applicant: please print or type Applicant Name: First Name M.I. Last Name Street Address or P.O. Box City State Zip Code I waive the right to review this recommendation. Telephone Number SIGNATURE OF RESIDENCY APPLICANT To the recommender: In addition to the letter of recommendation please return this completed form by January 6 th to Julia Schimmelpfennig, PharmD, MS, BCPS, CDE PGY-1 Residency Director/Clinical Pharmacy Manager St. Elizabeth's Hospital 211 South 3rd Street Belleville, Illinois 62220 Julia.Schimmelpfennig@hshs.org Applicants to the residency program specified above are required to have recommendations submitted by persons who are in a position to evaluate their qualifications for residency training. The recommender is asked to make a frank appraisal of the applicant's character, personality, abilities and suitability for a pharmacy residency. Recipients of this information are asked to keep it confidential. For the recommender to complete: I have known the applicant for approximately (months) (years). My relationship to the applicant was (or is) in the following capacity: faculty advisor employer clerkship preceptor supervisor other faculty relationship other (please specify) I know the applicant: very well fairly well only casually Does the applicant possess any special assets which should be noted? Does the applicant demonstrate any weaknesses which you feel would hinder his/her ability to perform effectively in a residency program?

Relative to persons of similar background, training and professional interests, how would you rate this applicant for each of the following characteristics? Please place an X under the rating column which best describes the applicant. CHARACTERISTICS EVALUATED UPPER 10% UPPER 25% UPPER 50% LOWER 50% NO BASIS FOR JUDGMENT Academic ability Quality of work Written communication skills Oral communication skills Leadership skills Industriousness and perseverance Initiative and motivation Assertiveness Cooperativeness Ability to organize and manage time Ability to work with supervisors Ability to work with peers Ability to work with patients Dependability Resourcefulness and originality Willingness to accept constructive criticism Personal appearance and professional demeanor Commitment to professional practice Emotional stability and maturity Enthusiasm Integrity Additional Comments: Recommendation concerning admission (check one): I highly recommend this applicant I recommend this applicant, but with some reservation I recommend this applicant. I am not able to recommend this applicant Signature of Recommender Date Name-typed or printed Title and affiliation ( ) Street address or P.O. Box, City State Zip Code Telephone Number

Benefits Benefits follow those outlined in the St. Elizabeth s Hospital Manual which may be accessed on the People Services internet site. These include but are not limited to: Competitive stipend Health, dental, and life insurance Twelve days paid time off Ten days of professional leave Travel, lodging and registration for three professional meetings Requirements Graduation from an accredited College of Pharmacy Doctor of Pharmacy or equivalent experience Eligibility for licensure in Illinois General employment requirements stipulated by St. Elizabeth s Hospital Application materials and program description may be found at www.steliz.org/pharmresidency For inquiries contact: Julia Schimmelpfennig, PharmD, MS, BCPS, CDE Residency Program Director Department of Pharmacy St. Elizabeth s Hospital 211 South Third Street Belleville, Illinois 62220 Julia.Schimmelpfennig@hshs.org (618) 234-2120, ext. 2426

211 South Third Street, Belleville, Illinois 62220 (618) 234-2120 www.steliz.org