International Observership Program

Guidelines Application CV- Credit Card - Immunization Record Forms

Enclosed please find all information and forms required should you be accepted into our program.
Application for Observership Program Form to be returned via e-mail: aghint@wpahs.org
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)

Application Observership Program Form

Curriculum Vitae CV
Copy of Passport and Visa Documentation
2 Letters of Recommendation
Letter of Character Reference stating no Criminal Background
If Graduate - Copy of Diploma
Immunization Record and Medical History (see immunization form)
2 current PPD screens from past year, if the test was positive, a chest X-Ray is required.
Copy of International Medical Insurance Card.
Observership Program Application Fee $500.00 (You may use credit card form attached).

Our contact information:

Allegheny International
490 E. North Avenue,
Professional Building, Suite 520
Pittsburgh PA 15212 USA
E-mail: aghint@wpahs.org

FEE

One Month:

Observership Program Total fee $ 2,500.00/month

($500 fee to be charged at time of acceptance, remaining balance
charged 2 weeks prior to start date)

REFUNDS
Fees are only refunded: 1) If we cannot place you or 2) You are unable to obtain a visa to
travel

After Allegheny International confirms your acceptance to the program, you will receive an
Acceptance Letter which you can present to your Hospital, University, Consulate and
Immigration. You will be required to sign and return the acceptance letter. Any observers
requesting a change to their scheduled observership will be charged $200.

Hospitals affiliate with the International Observership Program. We will do our best
to accommodate you if the areas are available. Limited up to two months.
Pittsburgh:
Louisville:

Allegheny General Hospital

Norton Health Care Hospital

and
and

West Penn Hospital

Kosair Childrens Hospital

Orientation day:
Please plan to arrive at our office at 10:00 AM unless we arrange otherwise with you. We will email you directions and a map the week before you start. At orientation, you will complete
paperwork, receive a temporary ID badge and receive instruction and background information.
You will then be escorted to your sponsoring physicians office.

Working Hours
Clinic (outpatient) services are typically 8:00 A.M. to 5:00 P.M., Monday through Friday.
Hospital services vary with each department. The Elective Coordinator in each department will
provide your specific working hours. US-recognized holidays, such as Memorial Day, July 4 th,
Labor Day, Thanksgiving, Christmas, etc. are observed.
Identification Badges
A temporary ID badge will be issued to you at your orientation. You must wear your ID badge at
all times while in the hospital, and return your ID badge when your program is completed.
Dress Code
The observer is expected to dress in a professional manner. You are required to wear a white lab
coat while in the hospital. Jeans, t-shirts, cutoffs, etc. are not allowed at any time. It is
recommended that you wear comfortable shoes. Surgical scrubs will be provided for those that
enter the operating room. During your clinical rotation business dress is required.
Transportation
The observer is responsible for their own transportation for their entire program including airport
transfers. See last page of this package for taxi and bus information.
Housing and Meals
The observer is responsible for his/her own accommodations and food. However, several housing
options exist within walking distance near the Hospital. Please see the housing form below.
Emergency Medical Care and International Medical Insurance
All observers are required to have International Medical Insurance. Bring your insurance card
with you. Please contact your insurance provider in the United States for approval and referral
before you use your medical insurance in the Emergency Department or in a physicians office.
Absence
Excused absences are limited during the observership. Unexcused absences may result in an
incomplete observership.
Teaching Conferences
Observers are encouraged to attend the numerous teaching conferences offered at the Hospital.
Evaluations
The Hospitals affiliated with Allegheny International cannot provide an evaluation or letter of
recommendation. However, a certificate of completion will be provided at the end of the
observership program.

Sample of Curriculum Vitae Format

Do Not Complete
Please submit formal typed CV
PERSONAL DATA
NAME:
GENDER:
PARENTS:
ADDRESS:
ZIP CODE:
E-MAIL:
CONTACT PHONE:
MOBILE PHONE:
PASSPORT NUMBER:
EXPIRATION DATE:

BIRTHDAY:

AGE:

COUNTRY:
FAX:
VISA ISSUED DATE:

PROFESSIONAL EXPERIENCE
UNIVERSITY/ MEDICAL SCHOOL
NAME:
COURSE OF MEDICINE:
DATE OF GRADUATION:
WEB-SITE:
ADDRESS:
DEANS or DIRECTOR NAME:
CONTACT NUMBER:

ZIP:
FAX:

HIGH SCHOOL
NAME:
ADDRESS:
LANGUAGES:
CLINICAL EXPERIENCE:
RESEARCH EXPERIENCE:

SCIENTIFIC PUBLICATION
PRESENTATIONS
GRANTS and AWARDS
EXTENDED EDUCATION
and Symposiums

Congresses, Courses, Journeys, Meetings

REFERENCES are required from (University,

Physician)
1- Name Address Telephone E-mail
2- Name Address Telephone E-mail

Hospital,

Teacher,

3- Name Address Telephone E-mail

APPLICATION FOR OBSERVERSHIP PROGRAM FORM

Date: ____________________________
Name
MS MRS MR DR
Mailing Address (Street, City, State, Country, Postal Code)

________________________________________________________________________________
________________________________________________________________________________
E-mail Address: ___________________________________________
Phone Numbers: _______________________________________________________________________
Country
Area Code Home Phone
Cell
Fax
List area of preference for Observership. We will do our best to accommodate you in one of the
Hospitals if these areas are available. Limited up to two months.
*Note: If Internal Medicine, please list specific subspecialty areas.*
1) ________________________2) __________________________3) ______________________
No. of months? ______ Month/s: __________________ and/or __________________ Year: ______
Circle one^
MEDICAL EDUCATION
Student

MD

Resident

Other:

Name and Address of Medical School or Hospital.

English Level: Basic Medium Advanced Speaking: _____ Reading _____Writing ______
FEE
One Month:
Observership Program Total fee $ 2,500.00 (includes application fee)
Additional Month:
$2,500.00 per/month 2 month maximum.

1) Observership Program Application Fee $500.00 to be sent to Allegheny International Office

(We prefer to charge the application fee by credit card upon acceptance)
Credit Card to be charged by:

Allegheny International
490 E. North Avenue,
Professional Building, Suite 520
Pittsburgh PA 15212 USA

Balance due in full once the Observership has been approved. Please see attached credit card
form.

International Medical Insurance

All observers are required to have International Medical Insurance. Bring your insurance card with you
during your orientation.

Credit Card Form

Date: ________________
Observer name: _________________________________________
1. Upon acceptance, I authorize Allegheny International to charge
an application fee in the amount of $500 to the following credit
card for my participation in a medical observership.
2. I authorize Allegheny International to charge the full balance of
the observership fee 2 weeks prior to my start date.
Please circle which credit card you will use and complete the
information below:
MasterCard

Visa
American Express

Account Number: ______________________________________

Name of Card Holder:

___________________________________

Address including Zip Code:

__________________________________________
__________________________________________
_______________________
_________________________________________________________________
Expiration Date: ___________________
Security Code from back of card: __________
OR you may pay the remaining balance with cash on orientation day.
If you plan to pay with cash, please check here: __________
Dates of Observership: _____________________
Signature: _________________________________

Date: _________________

Please sign and scan to email: aghint@wpahs.org or fax to 412-3598048

Note: You will receive a receipt for the application fee in the mail and you will receive a receipt
for the observership fee at orientation.

Immunization Record & Medical History Form

All international visitors requesting enrollment must meet all requirements listed below.
Applicants should be free from symptoms of infectious disease at the start of their program.
Should you become ill with a communicable disease during your observership you are required to
notify your host physician and remove yourself from patient care activity.
PLEASE HAVE YOUR EXAMINING PHYSICIAN VERIFY AND COMPLETE THE
FOLLOWING DATES AND TITERS OF IMMUNIZATIONS.
PLEASE ATTACH TITER REPORTS, A RECENT HEALTH HISTORY AND A RECENT
PHYSICAL EXAMINATION SIGNED BY YOUR EXAMINING PHYSICIAN ALL
REPORTS MUST BE IN ENGLISH and MUST INCLUDE TEST DATES.
PLEASE COMPLETE ALL OF THE FOLLOWING:

Applicants Name: _________________________________________________

TUBERCULOSIS
*Two* negative tuberculosis two-step skin tests (TST) in past 12 months
Dates: 1. ___________
2. ___________
OR PROVIDE:
Documentation of positive TST with negative chest x-ray within past 12 months
and no signs/symptoms of active disease

MMR: (Measles, Mumps, Rubella Titers) Date(s)________ 2.________ 3.________

Titers: 1. ___________ 2. _____________ 3. ______________
3 DOSES OF HEPATITIS B:
Dates: 1. _____________ 2.______________ 3._______________ Titer:___________
(If not vaccinated, provide a documented positive Hepatitis B Surface Antibody)
CHICKEN POX (varicella)
Date(s)_______________ Titer: ______________
Have you had varicella? _____ YES _____ NO*
If yes, provide date: ________
*If no, you will need 2 doses of vaccine. Dates of vaccine: 1. _______ 2. _______
Examining Physicians Name: _______________________________________
Examining Physicians signature: ____________________________________

Office Address: _________________________________________________________

__________________________________________________________
Phone Number: _________________________
TWO WEEKS PRIOR TO OBSERVERSHIP, PLEASE SCAN AND E-MAIL
RESULTS OF A 9-PANEL URINE TEST.

Information about Drug Screening Urinalysis and

Vaccinations
The Allegheny policy requires that all international observers undergo a urine
drug screening for the following:
-

Amphetamines
Barbiturates
Opiates
Marijuana (THC) metabolite
Propoxyphene

- Cocaine metabolite
- Benzodiazepines
- Phencyclidine
- Methadone

If you cannot get any of the required medical tests done before
arriving in Pittsburgh, we can arrange for you to get medical tests
and vaccinations done here. If you are getting any medical tests
done here, you will need to come to our office on the Friday before
you are scheduled to begin your observership!!! If you do not
arrange to have this done the Friday before your start date, then the
start of your observership may be delayed until you are able to get
an appointment to have the test(s) completed. Please let us know
by e-mail if you would like to arrive the Friday before to have any of
the following tests completed. This is something to consider
BEFORE booking your flight and arranging your accommodations.
Below is a list of the tests we offer and their pricing:
TESTS:
Physical Exam
9-Panel
2-step TB Skin Test
Hepatitis B Surface
Antibody
Measles Antibody

VACCINATIONS:
$5
0
$5
0
$4
0
$3
0
$2
8

Mumps Antibody
Rubella Antibody
Varicella Zoster
Antibody

$4
0
$3
6
$3
6

3 Hepatitis B
Vaccines
MMR Vaccine
Varicella Vaccine

$60/ea
ch
$75
$130

*Payment for testing is made directly to Allegheny International prior to

receiving services.
In order to prevent a non-negative result, please list any medications below
that you are currently taking:
1. ______________________________________________
2. ______________________________________________
3. ______________________________________________
*You will need to provide a prescription if you are currently taking any
medications that may interfere with the drug screening.

International Medical Insurance Card

International Medical Insurance name: _______________________________________
Medical Insurance Address: ________________________________________________
_______________________________________________________________________
Phone Number: _________________________
Emergency Medical Care:
All observers are required to have International Medical Insurance. Bring the insurance card with
you. Please contact your insurance provider in USA for approval and referral before you use your
medical insurance service at the Emergency Department or a Physicians office.
I certify that the information given on this form is true, accurate and complete.
Signature of applicant: _____________________________________Date:________________

SAMPLE OF CHARACTER REFERENCE LETTER RELATING TO

CRIMINAL BACKGROUND CHECK
(sample means this is just an example)
ON INSTITUTIONAL LETTERHEAD IF POSSIBLE

Allegheny International
Allegheny General Hospital
RE:

Potential Observers Name

TO WHOM IT MAY CONCERN:

I am writing this letter on behalf of _________________ whom I have
known for ____________________ in the capacity of his/her
_________________.

To the best of my knowledge _________________ is a person of high moral

character and has no criminal background nor has he/she been involved in
any criminal activity.
Please feel free to contact me if you have any questions.
Sincerely,

Title

English Competency:
Observers at Allegheny International must have the ability to independently communicate
in English. If adequate English communication is unable to be established, Allegheny
International reserves the right to dismiss an observer from the program.
Please sign below to acknowledge that you understand this requirement.
___________________________________________
Signature

______________
Date

Skype Video Call Interviews for Language Assessment:

Before you are accepted into Allegheny Internationals Observership Program, we may
want to schedule a video call interview with you on Skype to ask you a few questions.
We need to make sure that you are able to understand and speak adequate English for
communicating with the physicians and staff at our hospitals. We will let you know if we
need to use this option during your application processing.
List your Skype User Name here: __________________________________

If you do not have the program Skype, please go to

http://www.skype.com/en/download-skype/skype-for-computer/ and download the
appropriate version. You will also need a webcam for the video aspect.

If we decide to interview you, we will contact you by e-mail to schedule your

Skype interview, sometime within 4-6 weeks of your application date.

To find out the difference in time for scheduling purposes, please go to a World
Clock website, such as: http://www.timeanddate.com/worldclock/
(Pittsburgh is in the same time zone as New York).

Housing & Transportation Information for Observers

Allegheny International does not arrange housing for observers, but we are glad to
share some recommendations for temporary housing in Pittsburgh below.
Most of the Observership Departments are in Allegheny General Hospital or at the
Federal North Building, which are both located in the North Side neighborhood.
(North Shore is close to North Side, but closer to the rivers). The Rheumatology
Dept. is located at West Penn Hospital in the Bloomfield neighborhood of Pittsburgh.
Hotels:
1. Hyatt Place
2. Residence Inn
3. Springhill Suites
Apartments:
1. International Guest House 2 blocks from Allegheny General Hospital.
E-mail: aghint@wpahs.org; See attached Guest House Info Page.
Address: 615 Tripoli Street, Pittsburgh, PA 15212.
2. Gerard T. Hayostek rents a house on the North Side; very positive reviews; $650/month
E-mail: ghayostek@centradoms.com; Phone: 412-860-1211
Address: 1206 Marvista Street, PGH, 15212
3. Connie Schwickrath rents a house in Sharpsburg; all positive reviews.
E-mail: Connielee628@yahoo.com; Phone: 412-853-2363;
Address: 112 10th Street, Pittsburgh, PA 15215

4. John. Phone 415-516-6000. Email address: 4inxent@gmail.com. $600/month plus

utilities; all positive reviews.
5. www.airbnb.com
6. www.rotatingroom.com
7. Craigslist: Sublets & Temporary: https://pittsburgh.craigslist.org/sub/
Roommates: https://pittsburgh.craigslist.org/roo/
8. http://www.apartmentguide.com/apartments/Pennsylvania/Pittsburgh/short-termavailable-5-miles-4id/
9. Near West Penn Hospital: Graham House Apartments:
http://www.grahamhouseapts.com/index.html
Some of our Indian observers have used these websites:
1. http://indianroommates.sulekha.com/pittsburgh-pa
2. http://www.indianroommates.in/Pittsburgh
3. http://www.pittsburghindian.com/classified/?view=ads&subcatid=19&cityid=1&lang=en
Transportation Information:
Buses: www.portauthority.org (must have exact change for bus at airport).
Taxis: 1. Pittsburgh Taxi: 412-321-8100
2. Classy Cab: 412-322-5080
3. 2 new phone apps/cab companies new in Pittsburgh: Uber and Lyft.
Car Rental: Zip Car - http://www.zipcar.com/pittsburgh/find-cars

Allegheny International Guest House

615 Tripoli Street, Pittsburgh, PA 15212
Guest House Photos:
https://www.flickr.com/photos/aghint/sets/
Background Information:
2 blocks/3 minutes walking distance to Allegheny General
Hospital
Located in the North Side/Deutschtown neighborhood
Fully furnished with private bedrooms.
Safe and secure home.
A member of the Allegheny International staff is a permanent
resident there.
Tenants must sign a 1 or 2-month lease depending on how long
they will stay.
Cost:
$625/month; payable only by credit card.
$300 security deposit required before move-in, returned to
tenant upon move-out if no property damage.

More Details:
1st Floor:
Living Room 1 (front entryway) large leather couch and leather
recliner chair.
Living Room 2 couch, chairs and brand new flatscreen TV
Kitchen Area all appliances, utilities and utensils provided.
Bathroom 1 shower, toilet, sink, towels provided.
Back Porch secure sliding door to back porch w/bench seating
2nd Floor:
Bedroom 1 - furnished
Bathroom 2 shower, toilet, sink, towels provided.
3rd Floor (top floor):
Lounge area sitting area, closet
Bedroom 1 - furnished
Bedroom 2 furnished
Basement: Washer and dryer, must provide your own detergent;
storage space for luggage.

International Guest House

Credit Card Form
*Please e-mail aghint@wpahs.org to reserve a room before submitting this form*
Date: ________________
Observer name: _________________________________________
1. I authorize Allegheny International to charge a one-time fee of
$300 to the following credit card for security deposit at 615
Tripoli Street, Pittsburgh, PA 15212.
2. I authorize Allegheny International to charge a one-time fee of
$625 to the following credit card for one month of rent at 615
Tripoli Street, Pittsburgh, PA 15212.

Please circle which credit card you will use and complete the
information below:
MasterCard

Visa
American Express

Account Number: ______________________________________

Name of Card Holder:

___________________________________

Address including Zip Code:

__________________________________________
__________________________________________
_______________________
_________________________________________________________________
Expiration Date: ___________________
Security Code from back of card: __________
Dates of Observership: _____________________
Signature: _________________________________

Date: _________________

Please sign and scan to email: aghint@wpahs.org or fax to 412-3598048

Note: You will receive a receipt for all payments.