Instructions for Change in Medical Director, Co-Medical Director, Temporary Medical Director -or- Acting Medical Director Personnel Change

1.    Complete This "Change in Program Personnel" Template and put on your Program Letterhead.  

2.    Provide a copy of the institution's Letter of Appointment and Acceptance.

       This letter must contain the following (3) items:     

	Signed by the President/CEO -or- Dean/Administrator
	Position Title
	The effective (start) date

PLEASE NOTE: If you do not have a  "Letter of Appointment and Acceptance" and need to create one, you may use this template.

3.    Provide a copy of the Medical Director's CV.

4.    Provide a copy of the Medical Director's State License.

5.     Please mail all (4) completed  documents to:     

         CoARC

       Mallory Nutt

       1248 Harwood Rd.
       Bedford, Texas  76021