Standardized Patient (SP) Request Form

Note: This form must be completed in one sitting. Please complete comments first externally and then copy/paste your responses in the form.

Please provide your contact info:
Detail:
Please note that while we do not have an unlimited number of SP's, we will do our best to meet your request.
Finance:
The hourly rate for SP's ranges from $18.00 to $22.00 per hour, depending on the event.
Please make check payable to The University of Chicago Medical Center Mail to: The University of Chicago Simulation Center 5841 S. Maryland Ave. Suite 119, MC 5030 Chicago, Il 60637
6 digit departmental fund code
Administrative person responsible for and authorized to make purchases.
Standardized Patient Usage Agreement

When standardized patients are used, temporary employee guidelines apply.  If for some reason you must cancel an event date, at least 3 weeks notice must be given to SP’s. If less than 3 weeks notice is given, SP’s must be paid a 4 hour minimum for that work date. For trainings canceled with less than 2 weeks notice, SP’s must be paid a 2 hour minimum for that training date.