{"id":5491,"date":"2023-06-23T09:34:04","date_gmt":"2023-06-23T13:34:04","guid":{"rendered":"https:\/\/www.bumc.bu.edu\/id\/?page_id=5491"},"modified":"2023-06-23T09:34:04","modified_gmt":"2023-06-23T13:34:04","slug":"faculty-reimbursement-request","status":"publish","type":"page","link":"https:\/\/www.bumc.bu.edu\/id\/faculty-reimbursement-request\/","title":{"rendered":"Faculty Reimbursement Request"},"content":{"rendered":"<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_15' >\n                        <div class='gform_heading'>\n                            <p class='gform_description'>Request reimbursement for any expenses to be charged to Infectious Disease accounts <\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_15'  action='\/id\/wp-json\/wp\/v2\/pages\/5491' data-formid='15' >\n                        <div class='gform-body gform_body'><ul id='gform_fields_15' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_15_9\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_15_9\"><label class='gfield_label gform-field-label' for='input_15_9' >Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_9' id='input_15_9' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_15_9_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_15_9_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_15_9' class='gform_hidden' value='https:\/\/www.bumc.bu.edu\/id\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_15_8\"  class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_15_8\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_15_8'>\n                            \n                            <span id='input_15_8_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_8.3' id='input_15_8_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_15_8_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_15_8_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_8.6' id='input_15_8_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_15_8_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_15_10\"  class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_15_10\"><label class='gfield_label gform-field-label' for='input_15_10' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_10' id='input_15_10' type='text' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_15_20\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_15_20\"><label class='gfield_label gform-field-label' for='input_15_20' >Phone Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_15_20' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_15_16\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_15_16\"><label class='gfield_label gform-field-label' for='input_15_16' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_16' id='input_15_16' type='text' value='' class='large'  aria-describedby=\"gfield_description_15_16\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_15_16'>Address for check to be mailed to (confirmation to reduce mailing errors)<\/div><\/li><li id=\"field_15_6\"  class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_15_6\"><label class='gfield_label gform-field-label' for='input_15_6' >Reimbursement Type<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_6' id='input_15_6' class='medium gfield_select'  aria-describedby=\"gfield_description_15_6\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='Grant Funded' >Grant Funded<\/option><option value='CME Stipend\/Faculty Allowance' >CME Stipend\/Faculty Allowance<\/option><option value='MD\/APP Required Expenses' >MD\/APP Required expenses<\/option><option value='Other' >Other<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_15_6'>1. CME Stipend\/Faculty Allowance \u2013 Annual stipend allocated to faculty for CME\/Professional Development. AY26 is budgeted at $2,000 per faculty per year and $1,000 for APPs per year. These funds cannot be rolled over to future years. \n\n2. MD\/APP Required Expense \u2013 The Section will reimburse physicians and APPs for the following expenses: Massachusetts Controlled Substance Registration, Drug Enforcement Administration (DEA) License Renewal, Board of Registration License Renewal, & Credentialing fees. \n\n3. Other\u2013 Reimbursement on an account other than what's listed above. For example, a Recruitment\/Development account (a financial agreement between DOM and a faculty member to support their program development\/research program).\n\n\n\n<\/div><\/li><li id=\"field_15_14\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_15_14\"><label class='gfield_label gform-field-label' for='input_15_14' >Account (nickname or project number)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_15_14' type='text' value='' class='large'  aria-describedby=\"gfield_description_15_14\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_15_14'>Note that BMC project\/grant number starts with a number 4, BU Internal Number starts with a 9<\/div><\/li><li id=\"field_15_17\"  class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_15_17\"><label class='gfield_label gform-field-label' for='input_15_17' >Is Grant Manager aware of expense?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_17' id='input_15_17' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Yes' >Yes<\/option><option value='Second Choice' >No<\/option><\/select><\/div><\/li><li id=\"field_15_7\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_15_7\"><label class='gfield_label gform-field-label' for='input_15_7' >Description of Expense<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_7' id='input_15_7' class='textarea medium'  aria-describedby=\"gfield_description_15_7\" maxlength='600'  aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_15_7'>What is the expense? 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