| Select the number of years experience in each subspecialty. |
| Cardiology |
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Dermatology |
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Emergency Med |
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Endocrinology |
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| Family Practice |
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GI |
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GU |
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Infectious Disease |
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| Neurology |
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Oncology |
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Orthopedics |
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Psychiatry |
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| Pulmonary |
|
Radiology |
|
Vascular |
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Rheumatology |
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| Urology |
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OB/GYN |
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Other |
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| TOOLS OF THE TRADE |
| Computer Operating System |
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| Internet access? |
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| CD-ROM? |
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| Word processing program you know best? |
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| Shortcut program you know best? |
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| Do you have a second phone line? |
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| Do you have an unlimited long distance calling plan? |
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| Are you a member of AAMT? |
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| Are you a CMT? |
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Indicate the days and hours you are available to work. Indicate a.m. or p.m. using EST hours.