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Moonlighting Privileges Request

Patient care and medical education must be the highest professional responsibility of the house officer. The House Officer and Program Director are also responsible to ensure compliance with both the letter and the spirit of the ACGME Duty Hours regulations. The Program Director may set guidelines that allow qualified house officers to moonlight. If the Program allows moonlighting, it is the responsibility of the Program Director to ensure compliance with Duty Hours regulations and Duty Hours Tracking.


Internal Medicine categorical residents who wish to moonlight must comply with the following:


  1. The resident has successfully entered the PGY3 level and has obtained his or her license.
  2. The moonlighting occurs in a Department of Medicine-sanctioned setting.
  3. The total number of hours worked in the Program and at the moonlighting does not exceed 80 hours per week, averaged over 4 weeks, and does not violate the Duty Hours regulations of the ACGME.
  4. The Program Director is aware of the nature and extent of the work and has reviewed its appropriateness.
  5. The house officer is not on probation or review status, has a satisfactory record of conference attendance (at least 60% averaged over the entire residency), has scored above the 30th percentile of the national sample on the In-Training Exam taken in the PGY2 year, and the resident has a strong record of professional conduct, including medical records completion, good attendance, lack of extraordinary sick days or absence from duty.
  6. The resident will not moonlight during inpatient ward or unit months, including the hospitalist rotation.
  7. The house officer must consistently report all moonlighting activity on an ongoing basis by submitting a Form at the end of each block. This form must accurately and consistently reflect the hours worked and the sites of moonlighting for that entire block. Failure to submit the form or misrepresentation of work hours or sites may result in loss of moonlighting privileges and possibly other disciplinary actions.


It is the responsibility of the resident to inform the Program Director of his or her intention to moonlight and to ensure that the 80 hour work week rule and other Duty Hours regulations are adhered to.


Permission may be requested by completing the Moonlighting Policy Acknowledgment / Application Form from the Residency Office and submitting it to the Internal Medicine Residency Office. The Program Director will review requests. The house officer may not begin to moonlight until after receiving written consent from the Program Director. Consent can be removed at any time if the house officer fails to maintain the standards set forth above.


Violations of this policy will be dealt with in the Competence Committee. Any house officer discovered to be moonlighting without permission or to be moonlighting more than the approved number of hours or at an unapproved site may be subject to disciplinary action up to and including probation and dismissal. House officers approved for moonlighting must file a Moonlighting Activity Tracking Form.


The University and School of Medicine malpractice insurance plan does not cover moonlighting activities.


Moonlighting Report Form


Name _________________________________  Block ________ Dates of Block _______________


I am authorized by the ROC to moonlight for _________ hours per week, at the following location(s) as long as total hours per week in any single week in the residency and at moonlighting do not exceed 80, and I am not on an inpatient ward, ICU, or CCU rotation, regardless of the total hours worked.


Location 1 _____________________________________________________


Location 2 _____________________________________________________


Location 3 ______________________________________________________


I certify that during the block just ended, I have moonlighted on the following schedule, reflected in the table below. I further certify that I have not worked more than 24 continuous hours during this period of time and that my total hours worked have not exceeded 80 in any single week. I understand that my primary work obligation is to my residency program and my education.

                                         Attach a copy of the official schedule.





Location #


Hours Moonlighting









































___________________________________________                            ___________________

Signature                                                                                                          Date


PD Initial [       ]



UCI   Department of Medicine

Internal Medicine Residency Program

Moonlighting Policy Acknowledgment And Application Form



  • I have received, read, and understand the Department of Internal Medicine Residency Program policy on moonlighting.
  • I understand that I must sign and return this document if I intend to moonlight.
  • I understand that I may contact the Program Director for clarification of this policy.
  • I understand that all moonlighting activities, including any changes in the hours or sites of moonlighting must be with the knowledge and approval of the Program Director.
  • I understand that I cannot begin moonlighting until I have received written authorization from the Program Director.
  • I also understand that I may be required to provide a statement of accountancy to document my tax records.
  • I understand that I must submit a copy of this form in the future if I wish to begin moonlighting or change my moonlighting sites or hours.
  • I understand that I must abide by all work hours regulations, and that these regulations include moonlighting hours.
  • I understand that the maximum number of moonlighting hours is 48 hours per block, and that I cannot moonlight during Ward, Unit or CCU assignments.
  • I understand that granting of privilege to moonlight does not confer Program or University sanction.  It does not constitute an educational experience. University malpractice insurance does not cover moonlighting.


     I wish to begin moonlighting at the following location and hours per month:



       Location #1                                              Responsibilities                                                    Hrs/Wk



       Location #2                                              Responsibilities                                                    Hrs/Wk




     NAME    (Print)                                                SIGNATURE                                                          DATE




CONFERENCE ATTENDANCE ________       STATUS ___________         INTRAINING SCORE _________%tile 



PROGRAM DIRECTOR SIGNATURE                                                                                              DATE