AAAAAA SSSSSS IIIIIIIIIII

telnet GothomCity)

MEDICAL BOARDt)jel303INDIVIDUAL NAME

LAST ISLEYFIRST MICHELLEMIDDLE M

RESIDENCE INFORMATION

PHONE:

AAAAAA SSSSSS IIIIIIIIIIIAAAAAAA SSS SSS IIIIIIIIIII

AAAAAAAA SSS SSS IIIASSESSMENT SYSTEMS, INC.

REAL SYSTEM(JR,SR,III)

COUNTYLGL ST

51

02-08-06V2 . 5.74 10:13:39 AMREFERENCE # MC00018390SOC SEC NUM

+-ADDITIONAL INFORMATION +SEX F = MARRIED Y =

OTHER NAMECORP. OFFICERTRUST ACCOUNT

BIRTH PLACE ELLENDALE NDDATE 09-27-1974

SCHOOL CODE 024020CE UNITS 0.00 REQD BY - -

NOTES

CURRENT STATUSRENEWAL STATUSCOMPLAINTS 0/C

I EXPIRATION DATE LAST ACTIVE DATE

0/ 0 AUTHORITY

02-08-2006 FIRST ISSUE DATE: LAST RENEWAL DATE:

02-08-2006

IMENU ttl 2AUTH DAT 3APPT DAT 4LICS DAT 5 ACCOUNT 6

1 - DOH Licensee Health Professional...

2 - DOH Licensee Soci...

ISLEY, MICHELLE MD00046097 PAGE 2


Medical Quality Assurance Commission

Physician Application Worksheet

Name ISLEY MICHELLE Date of Birth 09/27/1974

Date Received 2/7/06 Cash Number Candidate Number

X WSP Check X Fee X Photo X Datal-13 X AIDS X Attest X SSN X Garfield Search

Chronology

Complete to

Temp Permit Issued Number:

2/8/06

FSMB

2/8/06

AMA ECFMG Archive File

Personal Data "Yes"s Documentation Received Malpractice Cases Synopsis Disposition

Medical School

Name U OF MINNESOTA

School Code U.S.

Year of Degree 2002 2/3/06

Canadian

Transcripts

International

Translations

Examination Type National Boards FLEX I ' USMLE State Exam LMCC 1/12/06 Scores Received

Post Graduate

Received

Accrediation

Verified Received

Post Graduate Accredtallon

Verified

1/30/06OHIO STATE 8/02-8/08

2/3/06 OH

Approved /Signature Date /

Comments:

Deficiency Letters:

January

February

March

April

May

June

July

August

September

October

November

December


^7^

•

CV L/

^H

ealih

PHYSICIAN & SURGEON

REVENUE SECTION

^

\6,\a • m

PRINT NAME

RETURN THIS PORTION

WITH CHECK & APPLICATION \:- J: iov\j

laSSQ'ÔDaD ODEBt

ii"D5 2LII'

ISLEY, M

ICHELLE M

D00046097 P

AG

E 5

«2',-2/3/2Q06 :ior53.-53 AM- •0

602

• $^2

5. DO

06 o 3C/6^ 21•/

ISLEY, M

ICHELLE M

D00046097 P

AG

E 6

Back dround

Health^ eck Pro

1 lc;illli I'l' olijssions Qiuiliiy Assiirjncc['.0. i{ci\ 1099

Olympia. WA 9S507-I099

{-•5(k)) 230-47X5(jOO) 330-47X4

0,7-2006-

^®ssed

FOR OFFICE USE ONLY

vo ,o-

License To Practice MedicineApplicable For MD's Only

• National Boards

Q FLEX Examination

• Other State Exam

^ USMLE Examination

• LMCC (must have been obtained after 1969)

Please Type or Print Clearly—Follow carefully all instructions in the general instructions provided. It is the responsibility

of the applicant to submit or request to have submitted all required supporting documents. Failure to do so could result

in a delay in processing your application.

NOTE; Application fees are non-refundable. Make remittance payable to the Department of Health.

1. Demographic Information

APPLICANT'S NAME LAST FIRST

•jusleMIDDLE INITIAL

M.ADDRESS

COUNTY

NOTE: The mailing address you provide will be the a ddress of record. Your license document will show this address and allcorrespondence from the Department will be sent to this a ddress until you notify us in writing of a change. Ptirsuant toWAC 246-1 2-310, it is yo ur responsibility to maintain a current mailing address on file wit h the Department.

TELEPHONE (ENTER TH E NUMBER AT WHICH YOU CAN BE REACHED DURING NORMAL BUSINESS HOURS,)

SOCIAL SECURITY NUMBER (Required for license under 42 USC 666 and

Chapter 26.23 ROW)

GENDER

^Female •Male

BIRTHDATE (MO/DAYA-EAR)

0^ ai- (0(14PLACE OF BIRTH (CiTY/STATE)

Have you previously applied for a Washington State license or limited license? • Yes ^ No

Have you ever been known under any other name{s)? Q Yes ^ No

\\yes, list name(s):RECEIVED

HEIGHT

ql' FEB 0 7 2 006

EYE COLOR DEPARTMENT CP l-IE,.

WEIGHT

\40rm IR COLOR

MEDICAL SCHOOL YEAR OF GRADUATION

1001MEDICAL SPECIALITY

Qh cs 4 Go 10 u

DOH 657-020 (REV 7/2004) Page 1 of 4

2 - DOH Licensee Social Security Number - RCW 42.56.350(1)

1 - DOH Licensee Health Professional Home Address and/or Phone - RCW 42.56.350(2)

1 - DOH Licensee Health Professional Home Address a...


2. Personal Data Questions YES NO

1 - Do you have a medical condition which in any way impairs or limits your ability to practice your profession withreasonable skill and safety? If yes, please explain Q ^

"Medical Condition" includes physiological, mental or psychological conditions or disorders, such as, but notlimited to orthopedic, visual, speech, and hearing impairments, cerebral palsy , epilepsy, muscular dystrophy,multiple sclerosis, cancer, heart disease, diabetes, mental retardation, emotional or mental illness, specific learningdisabilities, HiV disease, tuberculosis, drug addiction and alcoholism,

la. If you answered "yes" to question 1, please explain whether and how the limitations or impairments caused byyour medical condition are reduced or eliminated because you receive ongoing treatment (with or withoutmedications).

1 b. If you answered "yes" to question 1, please explain whether and how the limitations and impairments caused byyour medical condition are reduced or eliminated because of your fteld of practice, the setting or the manner inwhich you have chosen to practice,

(If you answered "yes" to question 1, the licensing authority (Board/Commission or Department as appropriate) willmake an individualized assessment of the nature, the severity and the duration of the risks associated with anongoing medical condition, the treatment ongoing, and the factors in "l b" so as to determine whether an unrestrictedlicense should be issued, whether conditions should be imposed or whether you are not eligible for licensure.)

2. Do you currently use chemical substance(s) in any way which impairs or limits your ability to practice yourprofession with reasonable skill and safety? if yes, please explain Q ^

"Currently" means recently enough so that the use of drugs may have an ongoing impact on one's functioning asa licensee, and includes at least the past two years.

"Chemical substances" includes alcohol, drugs or medications, including those taken pursuant to a validprescription for legitimate medical purposes and in accordance with the prescriber's direction, as well as thoseused illegally.

3. Have you ever been diagnosed as having or have you ever been treated for pedophilia, exhibitionism, voyeurism or

frotteurism? • SI

4. Are you currently engaged in the illegal use of controlled substances? •

"Currently" means recently enough so that the use of drugs may have an ongoing impact on one's functioning asa licensee, and includes at least the past two years,

"Illegal use of controlled substances" means the use of controlled substances obtained illegally (e g,, heroin,cocaine) as well as the use of legally obtained controlled substances, not taken in accordance with the directionsof a licensed health care practitioner.

Note; If you answer "yes" to any of the remain ing questions, provide an explanation and certifiedcopies of all judgments, decisions, orders, agreements and surrenders.

5. Have you ever been convicted, entered a plea of guilly. nolo contendere or a plea of similar effect, or had prosecutionor sentence deferred or suspended, in connection with:

a. the use or distribution of controlled substances or legend drugs? •

b. a charge of a sex offense? .'. • ®

c. any other crime, other than minor traffic infractions? (Including driving under the infiuence and reckless driving) •

6. Have you ever been found in any civii, administrative or criminal proceedings to have:

a. possessed, used, prescribed for use, or distributed controiied substances or iegend drugs in any way otherthan for legitimate or therapeutic purposes, diverted controlled substances or iegend drugs, vioiated anydrug law, or prescribed controlled substances for yourself? •

b. committed any act involving moral turpitude, dishonesty or corruption? • 1^

c. violated any slate or federal law or rule regulating the practice of a health care professional? •

7. Have you ever been found in any proceeding to have violated any state or federal law or rule regulating the practiceof a health care profession? If "yes", explain and provide copies of all judgments, decisions, and agreements • 13,

8. Have you ever had any license, certificate, registration or other privilege to practice a health care profession denied,revoked, suspended, or restricted by a state, federal, or foreign authority, or have you ever surrendered suchcredential to avoid or in connection with action by such authority? O ^

9. Have you ever been named in any civil suit or suffered any civil judgment for incompetence, negligence ormalpractice in connection with the practice of a health care profession? •

DOH 657-020 {REV 7/2004) Page 2 of 4


2. Personal Data Questions (Continued) YES NO

10, Have you ever had hospital privileges, medical society, other professional society or organization membershiprevoked, suspended, restricted or denied? • gj

11, Have you ever been the subject of any informal or formal disciplinary action related to the practice of medicine? •

12, To the best of your knowledge, are you the subject of an investigation by any licensing board as to the dateof this application? •

13, Have you ever agreed to restrict, surrender, or resign your practice in lieu of or to avoid adverse action? • 3

3. Education And Experience

Provide a chronological listing of your educational preparation and post-graduate training.(Attach additional 8 1/2 X 11 sheets if necessary.)

Schools Atlended

(Location if other than U.S., quote names of schools in

original language and translate to English.)

Number of

Years Attended

Dales Attended Diploma or Degree Obtained

(Quote titles in original language and

translate to English,)

Schools Atlended

(Location if other than U.S., quote names of schools in

original language and translate to English.)

Number of

Years Attended From (mo/yr) To (nio/yr)

Diploma or Degree Obtained

(Quote titles in original language and

translate to English,)

Medical Education (List alt Medical Schools Attended)

ULV\Wt,>rS\VM o9 W\\v\V\oSo-Vt>-- OvjL\\jJtVs

SCVNOOV OV a 5 loo NIA

Sc^\AooV^ M VWtA-COi-poU'C.X- Lo 1 OO 6l0X DCC.-VDV o f Â.edvctv^c^

Post-Graduale Training (Lisi all Programs Atlended)

4. Professional Experience

In chronological order list all professional experience received since graduation from medical school to the present.(Exclude activities listed under other sections, identify any periods of time break of 30 days or more,)(Attach additional 8 1/2 X 1 1 sheets if necessary.)

Dates of Experience

From (mo/yr) To (mo/yr)

^cs\devNCM . TV\c oWvo , Co\wvwbui , oH" OX U 1 OLp

5. Hospital Privileges

List hospitals in the U.S. or Canada where hospital privileges have been granted within the past five (5) years.(Attach additional 8 1/2X11 sheets if necessary.)

NAME OF HOSPITAL

(For locum tenens, enter only those of a 30 day or longer duration. See instructions regarding reports and verification.)

DatesNAME OF HOSPITAL

(For locum tenens, enter only those of a 30 day or longer duration. See instructions regarding reports and verification.)Beginning

(mo/yf)

Ending

(mo/vr)

IW\\/6 V\CVOr CLPpUcd fo-r pv'tvjilcqeS' (VN (X^M

1

beccuASe' "X- Wivro \b CA- reSide^Cw

rCcw^'J r J

DOH 657-020 (REV 7/2004) Page 3 oM


6. Licenses In Other States

List all licenses to practice medicine in any state. Canadian province or oilier country.

(Include whether active or inactive.

Slale, County or Province

Ohio

Date License Issued

|03ca4

License Number

Basis of Licensure Siaius of License iExaminaiion(Dale Passed) Endorsement [ /Active

X

Inaciluc

Any Limiiaiionson License

No • Yes

• No n Yes

Q No • Yes

• No • Yes

7. Fifth Pathway (foreign-trained applicants only) (Attach additional 8 1/2 X 11 sheets if necessary.)

Name and Location of Fifth Paihv.ray Program Name and Location of Hospital Dates Attended

Name and Location of Fifth Paihv.ray Program Name and Location of Hospital Beginning Ending(mo/yr) (mo/yr)

NIA 1 18. AIDS Affidavit

I certify I have completed the minimum of four hours of education in the prevention, transmission and treatment of AIDS,

which included the topics of etiology and epidemiology, testing and counseling, infectious control guidelines, clinical

manifestations and treatment, legal and ethical issues to Include confidentiality, and the psychosocial issues to include

special population considerations. I understand I must maintain records documenting said education for two (2) years

and be prepared to submit those records to the Department if requested. I understand that should 1 provide any false

information, my registration may be denied, or if issued, suspended or

revoked.

APPLICANT'SINITIALS DATE

112-^/Dip

9. Applicant's Attestation

Name of Applicant, certify that I am the person described and identified in

this application; that I have read RCW 18.130.170 and 180 of the Uniform Disciplinary Act; and that I have answered

all questions truthfully and completely, and the documentation provided in support of my application is, to the best of my

knowledge, accurate. I further understand that the Department of Health may require additional information from me

prior to making a determination regarding my application, and may independently validate conviction records with official

state or federal databases.

I hereby authorize all hospitals, institutions or organizations, my references, employers (past and present), business and

professional associates (past and present), and all governmental agencies and instrumentalities (local, state, federal, or

foreign) to release to the Department any information files or records required by the Department in connection with

processing this application.

I further affirm that 1 will keep the Department informed of any criminal charges and/or physical or mental conditions

which jeopardize the quality of care rendered by me

10 the public. Official Use Only

Should I furnish any false or misleading information

on this application, I hereby unders tand that i.- 1. 1. n M.such act shall constitute cause for the den ial, Washington StatG RGCOrds CGntGT

suspension, or revocation of my license to

practice in the State of Washingtpq.

FEB 0 3 2006

CSC

UV\l(.iuUc L Signature of Appiicar

X'i Date

DOH 657-020 (REV 7/2004) Page 4 of 4


USMLEUnited States

Medical

Licensinfj

Exainjnation

United States Medical Licensing Examination " (USMLE "

Certified Transcript of Scores

This document was prepared by the

Federation of Stale Medical Boards of the United States. Inc.

Federation Place, PO Boi 619850. Da iJas, T\ 75261-9850 - Telephone (817) 868-4041

Date: 01/12/2006

Kecipient;

Washington Medical Quality Assurance Commission

ATTN: Doron Maniece, Exec Director

310 Isrcal Road SE

Tumwaier, WA 98501

Examinee:

Alt Name(s):

Isley, Michelle

Isicy, Michelle Marie

Examinee ID#:

Dale of Birth:

5-078-504-7

09/27/1974

Results for Steps taken by this e.xaminee (and for which results have been reported to dale) are shown below, For Steps lhai span more

than one day, Ihe test dale reflects the day on which the examination began. Where numeric scores are reported, there are two scales used

and the recommended minimum passing score ("MP") on each scale is shown in pa rentheses.

USMLE STEP 1

Test Date

06/02/2000

Pass/Fail

Pass

Three-Digit Score

Total MP

208 179

Two-Digit Score

Total MP

84 75

Comments

LISiVlLE STEP 2

Clinical Knowledge (CK)

Test Dale

12/22/200!

Pass/Fail

Pass

Three-Digil Score

Total MP

208 174

Two-Digit Score

Total MP

84 75

Comments

USMLE STEP 3

OHIO

Test Date

09/26/2003

Pass/Full

Pass

Three-Digit Score

Total MP

189 182

Two-Digit Score

Total MP

77 75

Comments

NOTE: A search of the B oard A ction Data B ank of the Fede ration of Slate Medical Boards (FSMB) reveals no reported infomiation on this e.xaminee.

This document was printed from a secure website and accurately reflects score information maintained by the FSMB.

CDS V051221 16459008 Page 1 of 2


Interpretation of results

USMLE iranscripts include a complete results history' and notations of any examinations for which the exam inee sat and no results were reported, e.g..

"Incomplete," On those Step examinations for which numeric scores are reported, two different scales are used. The first is a three-digit score sc ale

on which most scores fall between 140 and 280. The recommended minimum passing score is shown on the front of the transcript next to the

examinee's score for each administration. The second is a two-digit scale on which a score of 75 is the re commended minimum passing score. The

level of proficiency required to meet the recommended minimum passing level for each USMLE Step is reviewed periodically and is subject to ch ange.

For examinations w ith reported scores, the Standard Error of Measurement (SEM) provides an index of the variation that would be expected to occur

if an examinee were te sted repeatedly using different sets of items covering similar content. The SEM is usually in the range of 4 to 8 points on the

ihree-digit scale and 1 to 2 points on the two-dig it scale.

STEP 2 CLINICALSKILLS (CS)

The Clinical Skills (CS) component of Step 2 vv as introduced in 2004 and the USMLE transcript has been modified to reflect this chang e. The Step 2

examination that ex isted prior to the introduction of Step 2 CS continues to be administered as the Clinical Knowledge (CK) component of Step 2.

The label "Step 2 CK" is used for this examination whether taken before or after the introduction of the Step 2 CS component,

Step 2 CS results arc reported as pass or fail. Mad the two-digit reporting scale been used, examinees would have had to ach ieve a score of 75 or

higher in order to pass,

Some individuals may be required to ta ke and pass Step 2 CS prior to registering for Step 3. Transcript users can find information on eligibility

requirements for all USMLE examinations in the USMLE Bulletin of Information and from periodic Slcp 2 CS updates, available at the USMLE

website fwww.usmle.org V

ANNOTATIONS APPEARING UNDER "COMMENTS"

Circumstances in connection with an administration shown on this transcript may result in one or more a nnotations listed next lo the score, A

description of each "Comment" is provided below:

Indeterminate • Results tha t cannot be certified as representing a valid measure of the examinee's knowledge or competence as sampled by the

examination. Decisions to classify results os indeterminate may be made on the basis of factors that include, but arc not limited lo. unexplained

inconsistency of performance within the examination or between administrations of the same Step. No score is repor ted. Information regarding the

nature of the indeterminate score and the determination of the Committee on Score Validity is available. I f such information is not enclosed within

this transcript, it may be obtained by contacting the organization from which you received th e transcript or the USMLE Secretariat. 3750 Market

Street, Philadelphia. PA 19104, t elephone (215) 590-9700.

incomplete - The examinee sat for some, but n ot all, of the scheduled examination. N o score Ls reported.

Irregular Behavior - The Committee on Irregular Behavior determined that the examinee engaged in irregular behavior. Examples of irregular

behavior are described in the current edition of the USMLE Bulletin of Information. Information regarding the nature of the irregular behavior and the

determination of the Committee is available. If such information is not enclosed with this transcript, it may be obtain ed by contacting the organization

from which you received the trans cript or the USMLE Secretariat, 3750 Market Street, Philadelphia, PA 19104, telephone (215) 590-9700.

Score Not Available - The score is not available. Further review and/or analysis may be pending, or it may have been determined that the score

cannot be reported.

Test Accommodations • Following review and approval of a request from the exam inee, test accommodations were provided in the administration of

the e.xaminaiion,

ANNOTATIONS APPEARING AS "NOTE"

Circumstances noi in connection with an administration shown on this transcript may result in one or more annotations and an explanation or

instructions to contact the appropriate individual or organization. The "Note" will appear at the en d of the document.

BOARD ACTION DATA BANK INFORMATION APPEARING AS "NOTE"

The Board Action Data Bank of the Federation of State Medical Boards (FSMB) contains actions reported to the FSMB by U.S. licensing and

disciplinary boards, Canadian licensing authorities, the U.S. Armed Forces, the U.S. Department of Health and Human Services, and other

credenlialing entities To be included in the Data Bank, an action must be a matter of public record or be legally releasable to state medical boards or

other entities with recognized authority to review physician credentials. Certain actions reported lo and released by the Board Action Data Bank are

not disciplinary or otherwise prejudicial in nature. Such actions are reported lo ensure that records are complete and to assist in preventing

misrepresentation or the use of lost or stolen credentials by unauthorized persons, Once reported to the FSMB, an action becomes part of the

permanent record to the individual physician, and the existence of such an action may be indicated on the USMLE transcript by a "Note".

This document was printed from a secure website and accurafety reflects score information maintained by the FSMB.

CDS V051221 16459008 Page 2 of 2


UNIVERSITY OF MINNESOTAOFFICE OF THE REGISTRAR TRANSCRIPT RECORD

Univer6l&7 of MiimeMU. Duluch

UDiv€;«lLy of fllnneaotB Official Tra&0crlpc

RECEIVED

FEB 0 3 2 006

lUirc

Student ID

Birthibce

Mf* Mo 1

lelcy,Michelle mrle

1891671

09-27

Pi-lnL Uote 01-10-2006

HOST RB CBIT PICCRAKS

IneCituLlon University of Hinnesou, Tvin Cities

Medical School

Medicine K D Major

Doct

DEPARTMENT OF HEALTHHEALTH PROFESSIONS 5 ^

Uoivcrslty of Minnesota. Ouluth

School of Medicine, Duluch

Medicine Major

Course DescrlBCion Attsioted Samed Grade Points

1701

1171

Had Sthics

ttarv Syat

2.00

16.00

a.00 F.

13.00 E

Doctor o£ Medicine

03-11-2002

Medical School

Medicine M D

TEDM CPA : 0.000 TERM TOT/U.S : 20.00 20.00 0.000

BfCeetlva Fall 1999 the UBiveralty of Kinoeeeta converted to isnostera

Fall Sexeater 1999

University of Minnesota. Duluth

School of Medicine, Duluth

Medicine Major

\ - - - BeginoSae of Medicine Reecrd CourEe tTcEcrinclon Attcroccd Earned Grade Poults

Fall Quarter 1996 IIHSC 6200 Bchav Med 2.00 2 OO E

UnlveraSty Of MinneBOta. Duluth mro 6441 Clinical Pcunds. Clcrltship I 2.00 2.00 P

School of Medicine, Duluth FMTO 6461 Preceptnrship III l.OO i.DC P

Medicine Major HQ) 6724 CI Hepato Syst 6.00 6.00 S

Course Description Attenoced Earned Grade ninte HQ) 6723 Rcaplr Syat 5.00 5.00 E

MED 6746 Fluid.BleclytCB 4.00 4.00 E

AIIAT 3S04 Hixran Groes Anatany 19.00 10.00 D

BHSC 5211 Medical Soclolc^' 2.00 2.00 P TERM GPA 0.000 THtM TOTALS : 20.00 20.00 O.DOO

SKSC 3230 Med PBy:lntervicv 2.00 2.00 E

fMED 3121 Preceptorshlp I 1.00 1.00 P Spring Seaeeter 200Q

KS> 3320 Prin Baaic Sci 13.00 13.00 B tjniveraity of Minnesota, Duluth


TERM CPA 0 000 TIM TOTALS 23.00 23.00 0.000 Medicine Major

Cmirae Deacrtnticn At i — iitad Earned

Minter Quarter 1999

Dnlvcrsity of MiroeBots. Duluth BHSC 5591 Std Med Behav Sci 2.00 2.00 p

School of Medicine, Duluth BHSC 6260 Pay See Aspect 111 2.00 2.00 0

Medicine Major I'>1ED 6442 Clin Rda,Clerk 11 2.00 2 00 p

•surse Deacriction AtteniDted F.imed Grade Points FMED 6462 Preceptorshlp IV 2.00 2.00 p

FMED 6502 Clin Pathol Conf II 1 H 1,00 p

BH5C 5301 Bio/£pi 2.00 2,00 S Km 6762 EndOcr.Reprod Syat 10.00 10. CO E

FWEaO 5122 PreceptoiaUp I 1,00 1.00 P MED 6773 integr Clin Med 6.00 6,00 s

KEU 5510 Itistopath 9.00 9.00 E t4Q) 6733 Dcmatol.M/S Syat 4.00 •i . 00 t

SS41 Hemat.Kost Def 11.00

•ITJiW CPA ; 0 000 TERM TOTAL S : 23.00

Spring Quarter 1999

Unlyeralty of Minnesota. Duluth


Medicine Major

Description Atteii'Ptsd Earned Grade Points

BHSC 5562 Hum B eliav Devel. Pro 6.00 6.00 s

FMQ} 5101 Fmed I 3.00 3.00 p

FMED 5105 Physical Diagnosis 4.00 4 .00 P

FMED 3123 PrecepcorstUp I 1 .00 1.00 P

FMm 550Q Cpc 1.00 1.00 p

KED 5566 CardiQvaoc Syst 10.00 10.00 B

C»ST

OTOL

UK)L

0.000 TERM TOTALS ; 29.00

Suaaer Sssestcr 2000

university of MimeBOta, Twin Cities

Medical School

Medicine Major

Deocription Attempted aamed Grade Polnta

7S00

7200

72D0

Ob/Gyn &c*ernahip

Surg Spec I Ocol

urology E*temship

6.00 6.00

2.00 2.00

2.00 a.CO

0.000 TERM TOTALS

TEW TOTALS :

THIS OFFICIAL UNIVERSITY TRANSCRIPT IS PRINTED ON SECURITY PAPER AND DOES NOT REQUIRE A RAISED SEAL

Dept of HealthMedical Quality Assurance CommissionP.O. Box 47866Olympia WA 98504-7866

In Qcconjsnce wiih the Family EtJucational Rlghrs and Privacy Aci ol »974, Intormation from this transcript may nol bo released toa third pany without wTiitsn coreent ol Lhf> siudeni. Explanatory legend and authenticity confirmation InformatJon on tiack.

Brenda Hay Herzlg, RegistrarUniversity of Minnesota - Duluth

PLEASE QUESTION AUTHENTICITY OF DOCUMENT IF SIGNATURES AND SEAL ARE NOT VISIBLE OR ARE DISTORTED.ISLEY, MICHELLE MD00046097 PAGE 13

KEY TO TRANSCRIPT

Acuclcniic Caiend;ir

The seme:>ter system slancd Fall 1999 for all University of Minnesota

J.ifnpiise.s. Prior to Fall 1999 tite University used a i[tianer system

with these exceptions: Law sehottl slarictl on semesters Fall I9S i,

and some College of Continuing liducation courses were tatigltt on a

.semester calendar but the credits reported as i.]iiaricr credits.

Aecredilatiun

The University of Minnesota is accredited by the North Central

Association ofCollcgcs and Secondary Sciiools. by ilie N'ationid

Council for ibe Accrcdiliiiion ofTeacher lidiicalion. and by many

other agencies.

Coiii sc (Class) Niiiiiliering System (fniin I'all

0000 to 0999 noncrcdii courses

1000 to 1999 primtirily for undergraduate.': In llrst year

2000 to 2999 primarily for imdcrgradiiaies in .second year

eOOO to ?999 primarily for iindeigraduaics in ihiril yeai

4000 to 4999 priniarils' for uitdergiadiiaies in fourth year, may be

applied 10 a Graduate School ilegree with approval by the student's

major Held and if latighl by a nicmher of the graduate faculty i>r an

individual aulltori/ed by ilie program to leach at the graduate level

.^000 to 5999 primarily ibr graduate .students bin iftiid and fourth

year undergradtjate.s may enri'li

6000 to 7999 for pnsibaecalaiiieate prol'essi()nal degree students

8000 to 99fJ9 for graduate slinlems

Print' Cttitrse numherins systems

For ("all 1970 through Summer 1999 (course numbering prior to [97(i

is noted in parenthesis):

0000 to 0999 noneredit courses

lOOOto 1999 (01-49) introduelory eoui.ses pi imariK'l(>r fre.shmen

and sophomores

3000 to 3999 (50 • 991 imermeiiiaie courses primarily for juniors

and seniors

5000 to 5999 (I (K) - 199) advanced courses for juniors, seniors, and

graduate students

8000 (0 8999 (200 ami higher) tor graduate and professional school

students

C!i'e(lit

Sianing i'ull 1999 - units are semester credit

Prior to i"all 1999 - units generally are ijuaner credit (see enlcndar for

e.vcepiion.s)

Thesis credit - an asleri.sk (*) will appear following the course tide of

courses miinbered 8777, 8SSS. or 8900 if the ilegrec award is shown

An asterisk (*) indicates graduate eivdit taken ihouuh (."ollcgc of

Coinimiiitg education (CoiKimiing Fdiication and H.'ciension prior to

Fall 1999)

This .scjuare on an original tran.script is printed in

ihermoehroniic ink. When rubbed or hreaibed on.

it will fade and then gradtially return to normal.

Grading Deflnitiuns

A - achievement that is outstanding relative to the level necessary to

meet course retjuiremenis

[3 —

achievement that is s ignineanily above the level necessary to

mecl course rct|uircmenis

C - acbievement that meets the course r equiicmeiits in every respect

D - acliievetnem that is worthy of credit even though it faiks to meei

fully the course requirements

I: - achievement thai is signiilcaniiy greater than the lc\'cl required

to meet the basic course.requireinenls but not judged to be

oiiislanding

F (or N) - represents fpilitre (or no creclii) and .signirie.s thai the work

was citlier (I) completed hut at a leve l of aehievemeni that is not

worthy of credit or (2) was not completed ;ind there was no

agreement between ibe insituelor and the stuiicnt thai the

student would be awaideii an I (see also I)

11 - (I lonors) used by Law School and Medical School <aily

I -

( Incomplete) assigned at the discretion ol'the insirucior when,

due to e.Mitioidinary eircumsianees. e.g., hospilali/ation. a

siinleni is prevenieil [Voin completing lite work ol'lhe course on

lime. Rei|uires a w liiien agreement between itisiruelor tind

sliident

K - assigned by tin insii iietor to irilieaie the course is .still in

progress ami that ;i grade can not be a.ssigned at the present lim e

NG -no grade required

O - represent.s outstanding athievement for Doctor of Medicine and

Doctor ofVcierrniny Medicine programs

I' - aeiiievenienl designating passing work

Q - aehievemeni designating passing work

R - a course related registration symbol

S - acbievement that is sat isfactory, whieii is equi\ alenl to it C- or

belter (C oi betier on lite Duhiili campus)—acliievemenl

required for an S is at tlic discretion of the instructor but may be

no lower thtin a C- (no lower than a C on the Diiluth caiiiptis)

T- le-si credit

V - registration as an aiulitor or visitor (a noii-gr;icle non-ercdii

registration)

W - entered by the registrar's otTico when the student ofneially

withdraws from a eourse after ilie second week

X - reported by the instructor for a student in a sequence ctnirse

wheie the grade c;mnoi be determined uniil the sequence is

complete - Ibe instructor is to submit a grade tor each

when

the sequence is complete

Y - assigned iVom I'all 1929 to Summer 1959 to indicate the student

canceled while doing passing work

Z - a.ssigned from Fall 1929 to Summer 1959 to indicate the student

canceled while lioing fiiiling work

On the Twin (2ilies campus liom laill 1972 through Summer 1977 and

on the Morris campus from !''all 1972 ihrougli Summer 1985. lite

ol'ficial University iranscripi included only positive aeademie

achievemeiit.s. Courses in which the studeiil received a grade of N or

a registration symbol of I or W did n<»i appear on the t ranscript.

For cumplete grading policy, see

htip://w\v w. limn.cd (i/uscna(e/pulicie.s/grnciingpuJicy. ill niJ

(irade/Numcric Point Average Formula

EtTcctive Ftdl 1997. grade point value.s were siandardii:ed for the

University, .All units e.xcepi Law use: .A = 4,(inn, A- = 3.667,

B+ = 3..3.53, 13 = 3.nnn R. - 2,667. C-t- = 2,333. C = 2.01H). C- = 1.667.

Dr = 1.333, D = 1.000. F = 0,1)00. I = O.OOO, K = 0.000. X = 0.000,

Effective Fail 2004, the Twin Cities campus Law Seltooi uses

University standard grading, with lite addition of A-J- = 4,333 and

excluding D+.

Before 1997, most units did not use -t-/-. Bui the Dutuih campus and

the SCIKH'I of Management usetl; A = 4.n. A- = 3.6. B-s =3.3.

B = 3.0. 13-= 2.6. C t'= 2.3.C = 2.0. C-= 1.6.1)1-= 1.3. D= 1.0.

F = 0,() and the Fwin Cities General College used .A = 4,0.

A-= 3.6. 13 =3.2. B- = 2.S. C ! = 2.-1. (!' = TO.C-= 1.6. D= 1.2. D-=

O.S. F = 0,0

Prior to I'all 2004, the Twin Cities campus Law School used a

numeric rather than a gta<[e point average for the///rA Jocior f.l./.).)

degree program, Grutles ranged from 4-16 points based on the

following: 14-16: li.\celleni.'OutsUmdiiig; I 1-13: Siibslanlially Ix'tier

iltiin average; S-10; Minimally acceptable; 5-7: Inadequate (credits

count towards degree completion, and NPA'j: 4; Failing; 0; Noii-

pei tormance. Classe.s for which a 0 grade was earned are not

included in NI'A ealciiialion. Grades earned in lite LI..M. (Master of

Laws) program were: A=4.U0. 13=3.00. C=2.00. D=I.OO. F=0.00. No

+/- distinctions are given.

Symbols Following C.'oitrsc Numbers

C —

eeriifieiiie ciedil

E - on Duiullt campus, registnilion in Coitlinuing Education, or

on Twin Cities ctimpus. an MBA eourse

(j - honors course Cor e.xtra credit

H —

honors eourse

J - evening .MBA couise Ibr extra credit

K - evening MBA course by independent stiidv'

L - honors eourse by independent study

M - extra credit by independent study

Q —

exciting MB.A e.xira credit by independent study

R — honors extra credit by Imiependent study

S — semester regisiiation (pre 1999)

T- semester honors course (pre 1999)

U - special term course taken for extra credit

V - honors and writing intensive

\V - writing intensive

.\' - extra credit

- independent Mudy

Z- special term registration

Second l.angtiage I'rollriency means ttemonslraied iniermediate

prollcieitcy in reading, writing, listening, and speaking.

Degree with dislinciion imiicates graduation with hiuii Gl'A; degree

with honois (laude) indicates completion of special honors program.

For more information see: w\vv\.uiiin.edu

CHnipus Kcrord*- orHct' tnoslliin^;

UnivtT'iic) I if Minicsvit.i. CriKikslur

170 (l»irn IIJII

Criwk.vlnn. MS' ShTUi-fOOl

I21S):SI-S5J3

Depl of I'liiii- Iti?! cU; iHUOn")

tiilivi-rsiti. ol'Miniu--ulj. DUIJIII

ISJ lljcl.inJ .xemiiiisiraliun fiuilJiny

Oiiliiih. MS 55Kl2--''t'l I

Dqii 111 IIJuc liixi cil: (lOlXSS

UiiiiLTsilv oi'MiiiiK'MJtLi.

212 lli-linilor Hall

Morris. MN .S&2n7.2l.t2

(j2U) SSO-toOjO

Dopl iil'liilui: Insi til; UO2.1X0

2001 r.isiT Hall

or

Miiineapr'lis, MS.1S455

t(il2) 024.1111

Dtjit III 1;0iii- lasl tU: 00.1'Ki'

Uiiittisilv ol XllniiesaU. I "in C'iliis

IJDL'iintyH.ai

OI

l?ll Wi-sl Udiik SkvM-iiy

.Si. J'jul. -MN 55IOX

,Miiim-a|Hilis. .MS s545.s

(iii2to24-i n I

i6i:)r,24.iin

I'lic Uriitrsiiv ul MiiintMiia. Wnstca tanipiis

closed in l''''2. Tor inlotntulioii on

xliiJciil [i.inscripo. toiildtl ikic .Si, I'aiil olTitc.

ISLEY, M

ICHELLE M

D00046097 P

AG

E 1

4

UNIVERSITY OF MINNESOTAOFFICE OF THE REGISTRAR TRANSCRIPT RECORD

UBivergicy o( Hisoagot* OCficisl Trangerlpt ll». 2

University of Kinnesota, Duluth

Studiait ID

Blrthdgte

laley.Hlcnelle Mirte

1S91S71

09-27 -

Pall Seeester 2000

Univcrslcy of Micnesota, Twin CiLlea

Medical Scticol

Medicine Major

Deaertpcion ftcccrcted Earned Grade Points

TSH GPfi : 0.000 TERM ITTThLS ; 14.00 14.00

Univarglty of Hinnaaota Sucnary Inforaation

Medicine Career Totela

FP01 7$01 Rural Physician Assoc Prograo S.OO 6.00

FP01 7601 Rural Phyoician Assoc Prograni 6.00 4.00

Km 7600 Med I Extemshtp 6.00 4.00

Actoqited Earned

UCI CPA I 0,000 UK) TOTALS : 196.01 196.01

CPA UNITS I 0.000 CUM TOTALS i 195,01

Polnta

0.000

TERM TOTALS

Spring Soeater 2001

University of Minnesota, Twin Cities

Medical'School

Medicine Major

Rural Physician

Description Attagited

••••• End of Transcript

Page 2 of 2

Earned Grade lînts

PPn 7601 Rural Physician Assoc Program 6.00 6.00

FfOi 7501 Rural Physician Assoc Program 6.00 6.00

FtOi 7601 Rural Physician Assoc Program 6,00 6.00

TERM CPA : TER.M TOTALS :

Sumner Senester 2001

University of Minnesota, Twin cities

Medical School

Medicine Major

Rural Physician

pgoeriptlon Atteiroted Earned Grade Points

FPOl 7601 'Rural ntyeiclon Assoc Progra m 6.00 6.00 H

•WD 7666 Elec Away 4.00 4 .00 H

Rural nr/siclans Associate Program fulfilled the requirements tor SURG 7S0G

Rural Aiysiclans Associate Program fulfilled the requircmcntn

for Pvijnary Care ClerV.ship INKD 7 506/7509

TfXI4 CPA 0,000 TERM TOTALS : 10.00 10.00 0.000

Pell Seaegter 2001

University of Minnesota, Twin ClLleo

Medical School

Medicine M D Major

Ccurca Deccrlotion Attamted Earned Grade Riinto

AD7V 7600 Psychiatry ^temahlp 6.00 6.00 H

HED 7501 Med 11 btemship 6.00 6.00 B

TERM GPA 0.000 TERM TOTALS ; 12.00 12.00 0.000

Spring Seaeeter 2002

University of Minnesota, Twin Cities

Medical School

Medicine M 0 Major

course Dencriotion Attanoted Earned Grade Points

KED 7521 Infect bis Elec 4 .00 4.00 H

n!d.lR 7610 Neurology btmship 4.00 4.00 B

FED 7501 Pediatric Extemship 6.00 6.00 B


In occordance with the Family Educational Rights and Privacy Ad ol 1974, Inlormatjon Irom this iranscrlpt may not bo releoaod toa IhlR] party wlUtout wmion conseni ol tho sludani. Explanatory legend and authenticity conllniialion IrrtormHtion on back.

•Ml:Brenda Hay Herzig, Registrar

University of Minnesota • Duluth

PLEASE QUESTION AUTHENTICITY OF DOCUMENT IF SIGNATURES AND SEAL ARE NOT VISIBLE OR ARE DISTORTED.

Unf


KEY TO TRANSCRIPT

Acjclcmic Cnlcndiir

The semesier ivsiom stancti Fall 1999 Tor all Univcreiiy orMinncsoUi

tampuse-s. Prior lo Fall 1999 [he Univeniily used a i|iiartcr system

with these exeepiions; Law sehool siariecl on semesiers I'all 1981,

and some College of Continuing Fdiictiiion courses were lauglii on a

^ semester calendar hui the credits reported as quttner credits.

Aecredicaliun

The L'niversiiy of Minnesota is accredited by the North Central

Association ofColleges and Seeondaiy Sciiools. by tlie Naiiontd

Council lor the Accrediltition ol'Teachei ndtication. and by many

other agencies.

Course (Class) Nuinhering Sysiem (from Fall 1999)

0000 to 0999 noncrcdit courses

lODO to [999 primtirily Tor iindcigiaduaics in lirsi year

2000 to 2999 primarily lor inidergraiiutites in second year

3000 to 3999 primarily lor iindeigraduales in third year

4000 to 4999 primarily for undergraduates in founh year, may be

applied to a Graiiiiate School degree with apptuval by the stucieni's

major Held and i f itiughl by a membei' o f the graduate facuhy or an

indiv idual auihoii/ed by the program to teach at the graduate level

5000 to 5999 primarily tor graduate siudcnis Inil third and fourth

year andeigraduates may enroll

6000 to 7999 for posibaecalaiireate professional degree students

8000 lo 9999 for graduate slitdenls

J'rior Ciitirsi- ntimhcring sysleins

For !"ali 1970 through Summer 1999 (course numbering prior to 1970


(1000 to 0999 noneredit eourses

1000 to [999 i('i-49) introdueiory eiMirses primarily li>r frcshmcii

and sophomores

3000 to 3999 (5() • 99) intermediate eotirses primarily for Juniors

and seniors

500(1 to 5999 (100 - 199) advanced courses I'oi juniors, seniors, aiul

graduate siudcnis

8000 to 8999 (200 and higher) lor graduate and professional school

students

Crciill

Starting I'all 1999 - utiits are semesler credit

I'tior lo Fall 1999 - unii.s generally are utianer credit (see calendar for

e.vcepiions)

Thesis credit - an asterisk (*) will appear follovs ing the course title of

courses numbered 8777. 8888. or 8999 ilThe degree award is shown

An asterisk (') indieaies graduate credit taken though C.'ollege oj'

Continuing lulucation (Continuing F.duetition and F.stensioii prior to

Fall 1999)

'fhis sc|uare on an ori ginal Iranseiipi is prinietl in

theiniochrnmic ink. Wlien rubbed or bretilhed on,

it will fade and then nradiiallv reiurti to normal.

(.•rading Drdnitinns

A - achievement that is oiiisianding relative to the level necessary to

meet course requirements

li - achievenieni lhai is signillcanily above the level necessary lo


C - achievement that meets the course rcquiremont.s i n every respect

D - achievemeiii that is worthy of credit even iliough it fails lo meet

fully the course requiremenls

1: - achievemeni that is signilicantly greater than the level rcquircil

to meet the basic course requirements hut nol judged lo be

outstanding

F (or N) - represents failure (or mr credit) and signities ihat tite vvork

was either {1) completed but at ;i level ol'achievemeiii lhai is nol

worthy of credit or (2) was not completed and there wiis no

agreement between the instructor and the student that the

student wotdd be awarded an I (see also 11

11 - 11 lonors) used by Law School and Medical School only

I - (lncom]ilcte) assigned at the discretion of the instructor when,

due to e.Mraordinarv' cireumsiaiices. e.g., hi»spiiali/alion, a

student is prevented from completing the WDrk of the course on

lime. Rei|iiires a written agreement between instiuclor and

student

K - assigned by an insiiucior to indicate the course is still in

progress anil (hat a grade can not be assigned at the present time

NCi -no grade required

0 - represents outstanding aehievemenl for Doctor ol'Mcdicine and

l.)actor of Veteriniiiy Medicine programs

P - achieventem designating passing work

(.) - achievement designating passing vvork

R - a course related rcgi.straiioii symbol

S —

achievement lluit is saiisfaelorr. which is equivalent lo a C- or

better ((J or better on die Dululh eampus)—tichievcmenl

required for an .S is at the disc retion ol'tlie instructor hut may he

no lower than a C- (no lower than a (J on the D iihtih campus)

T —

test credit

V - registration as an auditor or vi.sitor (a iion-grnde non-crcdii

regisliuiioni

V\'- entered by the registrar's office when the sludeni officially

withdraws from a course after the .second week

X - reported by the instnicior for a sliidcni in a sequence couise

where the gmUe cannot be dete rmined until the sequence is

complete - the instriieior is to submit a grade for eaeii X when


V - assigned Ironi Fall (929 to Simimer 1959 to indicate the situieiK

canceled while doing passing vvork

'/. - assigned from Fail 1929 to Summer 1959 to indicate the student

canceled while doing failing work

On the Twin Cities eampus from Fall 1972 through Summer 1977 and

on the .Morris campus I'rom Fall |972 ihrougii Summer 1985. llie

ol'lldal University transcript ineltided only positive academic

acliievemenls. Courses in w hich the siudeni reeeiveil a grade of N or

a registration symbol of I or W did not appear on the transcript.

Forcumplete grading ptdicy, see

htlp://www.umii.cdii/usentitc/p(dicie.s/<>r:idingpulicy.html

Cirade/Niiincric INdnt Average Formula

FtTeclive Ihili 1997. grade point values were standardized for the

University. All units except Law use: ,A = 4.000, .A- = 3.667.

= 3.333, B = 3.000 H- = 2,667. C i- = 2.333. C = 2.000. C- = 1.667.

D i- - 1.333, D = 1.000. F = 0.000, I = O.OOO, K = 0,000. X = 0,000.

LITeclive Fall 2004, the Twin Cities eampus Law School uses

University standard grading, with the addition of A+ = 4.333 and

excluding D-.

Before 1997, niost units did not use i/-. But the Dululh campu.s and

the Sciiool of Management used: A = 4.(1, ,A-3,6. ID - 3.3.

B = 3.0. B- - 2.6, c"i = 2,3. C = 2.0. C-= 1.6, [J i = 1.3. D- 1.0.

F = 0.0 and the Tw in Cities Genera! College used A = 4.0.

A- = 3.6. B = 3.2. B-= 2.8.C t = 2.4. C = TO.C- = 1.6. D= 1.2. 1)- =

0.8. F = 0.0

Prior to Full 2004, the '['win Cities campus l.aw School used a

ntimeiic ratlier than a grade point average t'or (lie /'fM i/ncior {.LD.)

degree prognun. Grjiies rangetl from 4- [ 6 points based on llie

following: 14-16: L.xcellont/Dtitslanding: I 1-13: Substantially better

than average; 8-10: Minimally aceeplable: 5-7: Inadequate (credits

ciuini towards degree completion, and NP.A): 4: Failing: 0: Non-

pert'ormanee. Classes foi which a 0 grade was earned are not

inchiticd in NPA calculation. Grades enrued in (he LL.M. (Master of

Laws) program were: A=4,l)(). B=3.()0. C=2,00. D=I.O(). F=0,00. No

•I- distinctions are given.

Symbols Foltnwinn C'onise Nuinhei s

C- cenificate credit

F— on Dululh campus, registration in Continuing Hducation. or

on Twin Cities eampus. an MBA course

G - honors course for e.siru credit

i I — honors coarse

J - evening MBA cmtrse for e.Mra credit

K - evening MB.A course by independent study

L - honors course by independent study

M - c.xtra credit by independent sluily

O - evening MB.A extra credit by indepcrulent siiidy

k - honors extra credit by independent study

S- semester rcgisiraliou (pre 1999)

T —

semester lionors course (pre 1999)

Li - special term course Uikcn for e.Mra crcilil

V —

honors and writing intensive

W - writing intensive

- extra credit

Y— independent study

'/. - special term regisiraiinn

Second Language Prolleicncy means demnnsiraled inlei mediate

prollciency in reading, writing, listening, and .speaking.

Degree with distinction indicates graduation with high fiP.A: degree

with lioiiors (luudc) indicates completion ofspecial honors piogmm.

For more information see: www.umn.i'dii

CamiiU'i Kicni'tis orncr liivailuii^:

UniM'friiy nf Minnch<'l:i. CUK)V.SI.>I>

J'UOMcnltiili

rroolvStoi). MN in' I ("SOd I

(:is):si-s5is

Depi of I-diw liiî cJ: ilO-KKi'J

Unbcrsiiy ut'.MiiiiK-'.ola. Itululli

isa l)arland AiltniiiKiraiii'n IluiiainK

tliiliiih. MX55Ri:-?dll

(491) 7:(vl;OflO

Dcpl ol'ltduc tnu id: (>II2?SS

I'liivcoilj oI'Miniii'.olj, .Xtoni

:i2 IWlTmicr Hall

iVIorru. XIN 564p'-2l.14

l.UUl 589-bO.'(i

Oi-pi >'1 l;duc tiiM III: ()U23S''

200 Frawi I Ijll

ot

Miiiiit-apoiis, MN 55-155

(oi;)o:a-ii 11

Pcpi •'( l-diic Insi id: dO.UJO''

IJnivitviiy or.\lmni.-Mila, "1 "in Cilii>

120 CoOV) I ) jll

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St- I'jiil. MN .<5I0K

.Minneapolis. .MN 55.15.'!

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(0I2)0:.1-II1I

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closed in t')*'2. )'or inloimaiioii on VViiecj

•siikliTii iranscripu. voiiciti ihc St, I'liul oiriia.

ISLEY, M

ICHELLE M

D00046097 P

AG

E 1

6

UNIVERSITY OF MINNESOTA

Dtihilh Ctnnpus

Office of financial A id and Repistrar

1049 Uiiiiciwily Drive

Diiliilh. Miniit'.\iii(i .55.S72-.<Cy//

u.**

:r. N

CO

Ff

X NC

o

02 1 A

$ 00-37^

000*3304391

JAN30 2006

MAILED FROM ZIP CODE 55012

i=-00«£- 0 1 •• : Ife

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ISLEY, M

ICHELLE M

D00046097 P

AG

E 1

7

UNIVERSITY OF MINNESOTA" OFFICE OF THE REGISTRAR TRANSCRIPT RECORD

Unlv«raity of Hlnoefloto Offiolol Troooeript Pa9a HO. 1

UniverslLy of Hisnesols. Twin Clcles tisme Isley.Hicholle Karia

Studnnt 10; 1891071

Birthdacfi : 09-37

Print, Date Dl'31-20oe

»nST P.ECEIfT PROGRAMS

Institution

Program

Plan

Degree Sought

University of Minnesota. Twin Cities

Medical School

Medicine M D Major

Doctor et Medicine

1 Suaaer Ouarter 1999

University of Minnesota. Duluth

School ot Medicine. Duluth

Medicine Major

Description Attermted

University ot Minnesota Dagrsea and CartlCicatss Awardad

BHSC

HSD

5701

557J

Med Ethics

Herv Syst

3.00

18.00

Earned Grade Points

2.00

10.00

Degree

confer Date

Acad Program

Plan

Doctor of Medicine

05-11-2002

Medical School

Medicine H D

TEW CPA : 0.000 TERM TCT TALS : 20.00 20.00 O.OOO

Effective Pall 1999 the University ef Klnsaseta eoovertsd to semesters

Pell Semester 1999

University of Mlnncaota. Duluth

School of Moillclne. Duluth

Medicine Xsjor

Course OeacriDClon Attamr.ed Earned Grade Points

Pall Quertar 199B BHSC 8200 Behav Med 2.00 3. go E

University of Kiimssota, Duluth FMED 6441 Clinical Rounds. Clerkship . I 2.00 2.00 P

school of Medicine. Duluth FMED 6481 Preceptorship ill 1.00 1.00 P

Medicine Major MED 6724 GI Hepato Syst 6.00 6.00 E

course Oeshriotion Attescted Earned Grade Points Mm 6720 Respir Syst 5.00 S.OO e

MED 6748 Fluid.Eleclytes 4 .00 4 . 00 E

AfJAT 5504 Hunan Gross Aitatony 10.00 10.00 0

aK$c 5211 Medical Sociology 2.00 2.00 p TERM CPA : 0.000 TERM TOTALS 20.00 20.00 0.000

6KSC 5290 Med Psy:Interview 2.00 2.00 E

5121 Pruccptorship I 1.00 1.00 P , Spring Semester 2000

MS) 5520 Prin Dsslc Sci 19.00 19.00 B University of Minnesota. Duluth

school of.Medicine. Duluth

TERM CPA : 0.000 TERM TOTALS : 20.DO 20.00 0.000 Medicine Major

Course DescriDtlOn Attomted Earned Crê Points

14 inter Ouartar 1999

University ol Minnesota, iTuluth BHSC 5591 Std Ked Behav Sci 2.00 2.00 P

School of Medicine. Duluth BHSC 6260 Pay Soc Aspect III , 2.00 2.00 0

Medicine Major P4ED 6442 Clin Rds.Clerk 11 2.00 2.00 P

Course Dearrintlon Attesroted Earned Grade Points FMED 6462 Preceptorship IV 2.00 2.00 P

FMED 6502 Clin Pathol Conf 11 1.00 1.00 P

BHSC 5901 Bio/EiJi 2.00 2.00 S MED 6762 Endocr.Reprod Syst 10.00 10.00 E

FMED 5122 Preceptorship I 1.00 1 .00 P MED 6773 Integr Clin Mod 6.00 6.00 S

MKD 5510 llistopatn 9.00 9.00 E MED 67BS Dermatol,M/g Syst 4.00 4.00 B

HBD 554 1 Kenat.Host Del 11.OD n.OO S

TERM CPA 0.000 TEPJ4 TOTALS 29.00 29.00 0.000

TERM CPA Q.OOD TERM TOTALS 29.00 29.00 0.000

Suaoiar Seaee Iter 2000

Sprln9 Ouartar 1S»9 University Of Minnesota. Twin Cities

University of Minresota. Duluth Medical School

School ef Medicine. Duluth Medicine Major

Medicine Major course Descn otlon Atroncted RamaH Grade Points

Course nesmoMon Ar.retmred Kamert Grade Points

OBST 75O0 Ob/Gyn Extemship 6.00 6.DO E

DNSC 5582 Hum B cliav Dcvel*. Pro 6.00 S.OO 9 OTOL 72O0 Surg Spec; OLOl 2.00 2.00 P

FMED 5101 Fmed I 9.00 3.00 F UROL 7200 Urology Extemship 2.00 2.00 P

FMED 5105 Physical Diagnosis 4.00 4 .00 P

FMED 5129 Preceptorship I 1.00 1.00 P TERM CPA 0.000 TE3W TOTALS 10.00 10.OO 0.000

FHES 5500 Cpc 1.00 1.00 P

KED 5588 Cardiovase Syet 10.00 10.00 E

TERM GPft 0.000 TERM TOTALS 25.00 25.00 0.000


Dept of HealthMedical Quality AssuranceCommissionPO Box 47866Olympia WA 98504-7866

RECEIVED

FEB 0 6 2 006

DEPARTMENT OF HEALTHHEALTH PROFESSIONS 5

In accordance with Ihe Family Educational Rights and Privacy Act ol 1974. Inlormauon from this Iranscript may noi bo roioosod 10a third party wllhoul wriuon consent of iho student. Eiplanatory legend and aulhcnilclty confirmation Information on bock.

Susan Van Voorhis, RegistrarUniversity of Minnesota - TWIn Cities

PLEASE QUESTION AUTHENTICITY OF DOCUMENT IF SIGNATURES AND SEAL ARE NOT VISIBLE'OR ARE DISTORTED.ISLEY, MICHELLE MD00046097 PAGE 18

ICEY TO TRANSCRIPT

Academic Calendar

-ITc scmesier sybicm siaried i'all 1099 for all Universiiy ofMinnesoUi

ciimpiisci. Prior to i-all 1999 llie University used a iiiiarter system

with these exceptions: Lav^' school started on semesters Fall 19S1,

ami some Collcee orCotitiiiuine lidiicalion courses wore taught on a

semester calendar hut the credits reported as i]uai1cr credits.

Accredilaiiun

I'he University orMinnest)la is accredited by the North Central

Association of Colleges and Secondary Schools, by the National

Council for the Accreditation ol'Teaehcr Fditcalion. and by many

otiicr agencies.

Course (Class) Numbering SvMciii (from I'all 1999)

0000 to 0999 noncrcdil courses

!()()() to 1999 primarily for undergnidiiaies in first year

2000 to 2999 primarily for iindcrgradijaie.s in second year

3000 to 3999 primarily tor undeigraduale.s in third year

4000 to 4999 primarily for undergiadnaies in fourth year, may be

applied in a Grtuluate School degree with approval by the student's

major field and iftaughl by a member of the graduiite factilly or an

individual authoriited by (he program to leach at the graduate level

5000 id 5999 primarily tor graduate students but third and fouiih

year undergraduates may enroll

0000 to 7999 for posibaccalameate profc.ssional degree students

SOOO to 9999 for graduate students

Prior Course numbering systemv

For Fall I97U through Summer 1999 (course numbering prior to 1970


0000 to 0999 norieredii courses

lOOOto 1999 ({11-49) iniKulueiory courses piiriiarily for fresiimen

antl sophomores

3000 to 3999 (50 • 99) intermediate courses primarily for juniors

and seniors

5000 to 5999 (100 - 199) advanced courses for juniors, seniois. and

gnidiiate siiidenis

SOOO to 8999 (200 and higher) for graduate and pr>l"essional .school

students

Credit

Starling Fall 1999 - units are semester credit

Prior to Fall 1999 - units generally are quancr creilii (see calendar for

e.vcepiions)

The.sis crcilit - an asterisk (*) will appear follovv ing (he course title of

courses numbered 8777. 8888. or S999 if the degree award is shown

An asterisk (*) indicates graduate credit taken (hough College of

Continuing Fducation (Comitming Fducaiion and F.xicnsinn prior to

Fall 1999)

This square on an original transcript is printed in

ihcrmochromic ink. When rubbed or breathed on.

it vvill fade and then gradually return to normal.

Grading neflnitious

A —

achievement thai is outstanding relative to the level necessary to

meet course requirement.s

B —

achievement that is signifieaniiy above the level necessary to

meet course reqiiirenienis

C - achievement that meets the course requirements in every re.speet

D - achievement that is worthy of eicdil even though it fails to meet

fully the course requiremerils

li - achievement that is signilieanily greater thtin the level required

to meet the basic course rcquirenients but not judged to be

outstanding

F (or N) - represents failure (or no credit) and .signillcs that the work

was either (1) completed hut at a l evel ol'achie\'emeni that is not

worthy of credit or (2) was not completed .ind there was no

agreement between the instrticior and the siudcni that the

student would be awarded an I (see also I)

U - (Honors) used by Law School and Medical School only

I - (Ineompleie) assigned at the discretion ofthe instructor when,

due to e.Mraordinary eircumstaiiecs. e.g., hospitalization, a

student is prevented from completing the work ofthe course on

lime. Requires a written agreement between iiisirnclor and

student

K - assigned by an instructor to indicate the course is still in

progress and that a grade can not be assigned at the pre.senl time

NG -no grade required

0 - represents outstanding achievemi'.nl for Uoelor of Mcilieine and

Doctor of Veierinajy Medicine programs

P - achievement designating passing work

Q - achievement tlcsignating passing work

R -

a course related registration symbol

S - aclucvcment that is satisfactory, vvhich is equivalent to a C- or

better (C or better on the Duluth campus)—aehievement

required for an S is at the disci etiori of the instructor but may be

no lower than a C- (no lower than a C on the Duluth campu-s)

T- lesicreilil

V - registration as an andiiur or visitor (a non-grade non-crcilit

I'cgislraliori)

W - entered by lite registrar's ol'llce when the student offtcially

withdraw .s from a course after the second week

X - reported by the inslniclor for a siudenl in a sequence course

where the grade cannot be determined until the sequence i.s

complete - the inslnictor is to submit a grade for eacit .X v > lien


V —

assigned from Fall 1929 to Summer 1959 to indicate the student


7. - assigned from Fall 1929 to Summer 1959 to indicate the student


On the Twin Cities campus from Fall 1972 through Summer 1977 and

on the Morris campus from Fall 1972 through Summer 1985, lite

otTcial University transcript included only positive academic

oehievcmenls. Courses in which the stuclcni received a grade ofN or

a registration .symbol of J or W d id not appear on the transcript.

For complete grading policy, see

hrtp://www.iimn.edii/uscnme/poJieics/grodlngptilicy.lilml

GradeyNuiiierie Poinl Average Fornutla

FtTeciive Fall 1997, gnide point values were standardized for the

University. All units except Law use: A =4.000. .A- = 3,667.

= 3.333, H = 3,O0n B- = 2.667. C+ = 2,333, C = 2.000. C- = 1.667.

D^ = 1.333, D= 1.000. F=-0.000. I = O.OOO. K = 0.000, X = 0,000,

llffeciivc I'all 2004. the Tw'in Cities campus Law School uses

University standard grailing. with the addition of A+ = 4.333 and

excluding D-i-.

Before 1997, most unit.s did not use -(•/- , But the Duluth campus and

the School of Management used: A = 4.0, A - = 3.6. Bt- = 3 ,3.

B = 3.0. B- = 2.6. C t = 2.3. C = 2.0. C- = 1.6. 1)+ = 1.3. D= 1.0,

F = 0.0 and the Twin Cities General College used A = 4,0.

A- = 3.6. B =3.2. B- = 2.8. C-t =2.4. C = 2.0, C-= 1.6. D= 1,2. D-=

0.8.1" = 0.0

Prior to i'all 2004, the Twin Cities campus Law School usoii a

numciic ratlier tlian a grade point average for thepiri\ Jncior U.D.i

degree pmgram. Grades rangetl lfom4-l6 points based on the

following: 14-16: Fxcellent/Ouisianding; 11-13: Subslaniially better

than average: 8-10: Minimally acceptable: 5-7: Inadequate (credil.s

count towards degree completion, and NP.A); 4: Failing;

Non-

perlbrniance. Classes for which a 0 grade was earned are not

included in N'P.A calcuiaiion. Grades earned in the LL.M. (Master of

Laws) program were; A=4.t)i). B=3,(10, C=2,0il. 0=1,00, F=0,i}0. No

H I- distinctions are given.

Symbols Following Coiii sc Numbers

C- cenifieate credit

F - on Duluth campus, registration in Continuing Hducation. or

on Twin Cities campus, an MBA course

G - honors course for extra credit

M - honors course

J - evening MBA course for extra credit

K - evening MB.A course by independent study

[. - honors course by indopcnileni .study

M - e.xtra credit by independent study

0 - evening Mi3A extra crciiii by independent study

R —

hoiu)rs c.xlra credit by iiulependeni study

S- semester registration (pre 1999)

T - semester honors course (pre 1999)

U - special term course taken for c.xlra credit

V —

lioiKus ujtd writing intensive

VV - writing intensive

X - extra credit

Y - independent study

7. - special term registration

Second Language Proficiency means demonstrated iiiiermetiiaie

proficiency in reading, writing, listening, and speaking.

Degree vviili distinction indicates graduation with high CPA: degree

with honors (laudc) indicates completion of special honors program.

For more information see: www.uiiir.edu

Cimput Hccofd^ ofTtcF lovaliuni:

Univcfsiiy of Minncsola, CtoolisKm

17(1 t7\v«n Kali

Crookslon. MN 5'i716-5(lOI

|2IS):.S|-S548

Oepiof Editc Insi e<J: OOJdo'J

UnWfnhy orMmnc-uu. Outuili

IM Uart.ind .Xdminisuaiiuii Huitding

nuliiih. MN55HI2-701I

12)81 72I)-8(K10

Dqit oriUliic IrvM id: 0027 SS

University oI'Minnevou, MorrU

212Ui-limlcr)lat)

.Moms, MN 56207-2132

(32iJ)58y-603a

[)qil of tiduc ]ii5i I'd: (KI23R9

200 r'tasct Hall

or

.Vtinneaprilis, MN 5.^-155

1612)62-1-1111

i;epl 111 t'liu c Insi id: 003%t

Uiiiiersity pf Minncsoia, T«in Cities

130 CofTey HPI!

PI

130 West BanL SUyuay

St. Paul. .MN 55108

MiniK-apolis. .MN 55455

(6l2t624-tlll

I6l2)624-ltll

The University oi'.Miiine.soii Wawo campus

cliiscJin 1962. Por iitforiiiation on Waseca

.studcni ir.invcripii. coiiiacl (he Si. Paul ulTli'c.

ISLEY, M

ICHELLE M

D00046097 P

AG

E 1

9

UNIVERSITY OF MINNESOTA' OFFICE OF THE REGISTRAR TRANSCRIPT RECORD

UDlverilcv ot Klnnaoeta OfClclal Trnoscript

UntvereiLy at Hinneaeo, Twin citiea li'aiM

Student ID

Blrthdate

Islcy,Michelle Kane

lasiSTl

09-27

Fall SaMaeer 7000

University of Hiiuiesoca, Twin Cities

Medical School

Medicine Major

Description Atterxated BaiTiod Grade Points

TERM SPA : O.OOO TERM TOTAJ^ ; 14.00 14.00

Upiveraicy of Kicinesoca Sumary Infomatlon

HedlclBa Caraec Totals

FTCH 7501 Rural Physician Assoc Progran 6.00 6.00 B Acto^tsd Earned Points

PFCH 7501 Rurel Physician Assoc Program 6.00 6.00 E UKU CPA ! 0.000 UHK TOTALS : 195.01 195.01 O.QOO

MED 7500 Meet 1 Extemship 6,00 6,00 0 CPA UHITS : 0.000 aw TOTALS : 195.01

TERM CPA 0. .000 TERM T OrUS : 18.00 18.00 0.000

Sprlap Soaacec 700X

Univeroity of Minnesota, TWin Cities

Medical School

Medicino Major

Rural Physician

Daacrlotion Atteimted

End of Transcript

Page 2 ol 2

Earned Grade Points

FPCH 7501 Rural Physician Assoc Program 6.00 6.00 0

FPOl ' 7S01 Rural Physician Assoc Program 6.00 6.00' 0

FPOt TSCi Rural Physician Assoc Program 6.00 6.00 0 -

TERM CPA : 0. ,000 TERM TOTAL S ; 18.00 18.00 0.000

Su^Btr Soaatar 7001

University o< Minnesota. Twin Cities

Medical School

Medicine Major

Rural Physician

De.scription Attercted Earned Crnde Points

rPCK 7501 Rural Physician Assoc Program 6.00 £.00 H

ItlMO 7555 Glcc Awoy 4.00 4.00 H

Rural Physiciahs Asaociata Prograai fulCilled the rnjulrcmcncs for SURGITSOO

Rural Physicians Associate Program fuKlllGd the requirements |

tor Primary Care Clerkship !HND 7508/7509 i

TERM CPA : O.DOO TEP.V TOTALS lO.'DQ 10.00

Pall Saaaatar 2001

University ot Minnesota, Twin Cities

Medical School

Medicine M D Major

Deacripticn Atteinoted Earned Grade Points

ADPY

MEO

7500

7501

Psychiatry Externshtp

Med 1 1 Gxtemsnip£.00

6,00

6,00

6,00

TERM TOTALS :

Bprlog Saaascsc 7002

University ot Minnesota. Twin cities

Medical School

Medicine M 0 Major

Deacrlption Attempted Earned Grsde Points

MED 7521

IiaiR 7510

PES 7501

Infect Sis Elcc '

neurology Extmshlp

Pediatric Extemshlp

4.00 4.00 H

4.00 4.DO E

6.00 6.00 E

jHis OFFICIAL UNIVERSITY TRANSCRIPT IS PRINTED ON SECURITY PAPER AND DOES NOJ REQUIRE.A RAISED SEAL

Susan Van Voorttis, RegistrarUniversity of MInnestota - IWin Cities

In accordance with ttio Family Educadona! Plights and Privacy Act ol 1S74. Informaiion tmm (his iranscdpl may not be released toa third party wiihotit written consent ol the siudoru. Explanatory logand and authenticity conflrmatlan information on back.

PLEASE QUESTION AUtHENTICITY OF DOCUMENT IF SIGNATURES AND SEAL ARE NOT VISIBLE OR ARE DISTORTED.ISLEY, MICHELLE MD00046097 PAGE 20

KEY TO TRANSCRIPT

Aradcniic Ciilendur

"The' semester system smrietl Fall

lor ail University of Minnesota

campuses. Frier to Fall 1WJ ilie University used a quailer system

willi tliesc exceptions: Law schouistarled on semesters Fall 1981.

and some College of Coniimiing ilducaiion courses were liiught on a

seniesier calendar hut the ercdils reported as i|iiarter crerlits.

Accredilaiion

The University oI'Minnesoia is accredited hy the North Central

Associtilitin of Colleges iind Secondary Schools, by the National

Council for the Accrediuilion ol Teacher Fdiication. and by many

other agencies.

Course iCIass) Numbering System (from Fall 1999)

0000 U) 0999 noncredit courses

1001) to 1999 primiiril)' Tor undeigniduaies in first year

2000_i() 2999 priniarily for undergrailiiaies in second year

2000 to 3999 primarily for iindergnduates in third year

4000 lo 4999 primarily Tor undcrgiaduaies in fourlh year, ntiiy he

applied to a (jraduate School ilegtec vviih iippmval hy llie stuclcm's

major field and iriatighl by a member ol'tlic graduate facility or an

individual aulhori/ed by ilie program to leach at the graduate level

5000 to 5999 primarily for graduate students but third and fouilh

year undeigrtiduates may enroll

6000 to 7999 lor posibacenlinircaie prol'essiotud degree siudcrils

soon lo 9999 for graduate students

Prior Coursi' numbering systems

For Fail )97() thiough SuinnKT 1999 (course numbering prior to 1970

is noted in pai cnlhesis);

000(1 to 0999 noncredit courses

1000 lo 1999 i(i|-'49) introductory eourses primarily for freshmen

and .sophomores

.3000 to 3999 (50 - 99| iniennediale courses primarily for Juniors

and seniors

. 5000 lo 5999 (101) - j 99) advanced courses for juniors, .seniots, and

graduate students

8000 to 8999 (200 and higher) for graduate and prolcssional school

siudcnls

Credit

Starting l"ali 1999 - units are semester credit

Prior to Fall 1999 - units generally arc i)tiancr credit (.see calendar for

exceptions)

Thesis credit - an asterisk (*) will appear I'ollowing the course title of

courses numbered 8777. 8888. or 8999 if the degree award is shown

An asterisk (*) indicates graduate credit taken Ihoiigh College of

Continuing Fdiication (Cnniinuing Fdncaiion and F-slension prior to

Fail 1999)

This square on an original transcript is printed in

thermochroniic ink. When rubbed or breathed on.

il vvill fade and then gradually relurn to normal.

Grading Dcllnltlons

A - achievement that is outstanding relative to the level necessary to

meet course requia-mcnts

B —

achievement that is signillcantly above the level Tiece.ssar> to


C —

achievement that meets the course requirements in every respect

f) - achievement that is worthy of creilit even though il fails to meet

fully the course requirements

F —

achievement that is significantly greater than the level required

to meet the basic course requirements but not judged to be

outstanding

F (or N) - represents failure for no credit) and signifies that (he vvork

was either (I) compieteil but ai a lev el of achiev ement that is not

w orthy of credit or (2) was not completed and there vv as no

agreement between the instructor and the student that the

student would be awaided an 1 (s ee also 1)

11 —

I Honors) used by Law .Scliool and Medical School only

I - (Incomplete) assigned at the discretion ofilie insinictor when,

due to cMiaordinary circumstances, e.g., hospilali/aiion, a

studcni is picvenied from completing the work of the course on

lime. Requires a wTilten agreeinent between instructor timl

studcni

K - assigned by an insitucior lo inJieuie (he course is still in

progress and that a grade can no t he assigned at the pi eseni lime

NG -no graile requircil

O —

represents onl.startiing aciiievcmoni for Doctor orMcilicine ami

Doctor v)fVeterinaiy Medicine programs

!' —

achievement designating passing wuik

Q - achievement designating passing work

R - a course related registration symhol

S - achievement that is .satisfactory, witich is equivalent to a C- or

belter (C or better on the Duluih campus)—aehievenieni

required for an .S i.s at (lie discretion of the instructor but ntjy be

no lower than a C- (no lower than a C on the Duhith campus)

T— test credil

V - registration as an auditor or visitor (a noti-grade non-credit

registration)

W - entered by the registrar's office when the siudeni officiiilly

withdraws I'lom a course after the second week

X —

rcpsincd by the insmictor for a student in a sequence course

w here the grade cannot be d eienniiied until (ho sequence is

complete - the instructor is to submit a grade fo r each when

the seiptence is complete

Y - assigned trom Fall 1929 to Summer 1959 to iniiicaie the .stiidcni


Z - assigned from Fall 1929 to Summer 1959 to indicalc ihe student


On the Twin Cities campus from Fall 1972 through Summer 1977 and

on the Morris campus from Kali 1972 through Summer 1985, (he

otTicial Univeoiity transcript included only positive academic

aehievciuenis. Courses in which the student received a grade ofN or

a registration symbol of I or W did not appear on the transcript,

For cnmplele grading policy, see

http://vvww.umii.edu/uscnatp/policics/gradingpoiicy. hind

(•rade/Nuincric Point Average Formula

I'lTeciive Fall 1997. gnide point values were standardized for ihe

University. All units except Law use: A = 4.000.

= 3.667.

13+ = 3.3i3. B = 3.000 n- = 2,667. C+ = 2,333. C = 2,000, C- = 1.667.

D- = 1,333. D= 1.000. F = 0,000. 1 = 0,000, K = 0.000. X = 0,000.

FiTeciivo Fall 2004, the Twin Cities campus Law School uses

University standard gratling. with the addition of A+ = 4,333 and

excluding D+,

F3efore 1997, most units did not use +/-. But the Duluih campus and

the Seliool of Management used: .A = -1,0, .A- = 3,6, Bs- - 3.3.

13 = 3.0. B- = 2.6. C+ = 2.3. C = 2.0, C-= 1.6. D+ = 1,3. D = 1.0.

F = 0.0 and the Twin Cities General College used .A = 4,0.

A-= 3.6. B = 3,2. B- = 2,8. C t = 2,4. C = TO. C-= 1.6. I) = 1.2. D- =

U.S. F = 0,0

Prior lo Fall 2004, the Twin Cities campus Law School used a

numeric raiher titan a grade point av erage for the /mv'v JiH.'lor (./.D.)

degree progjam. Grades ranged from 4-16 points based un the

following: 14-16: Lxceilent/Outsiandiiig: 1 1-13: Suhslaniially better

than average: S-IO: Minimally ticceplahle; 5-7: inadequate (credits

count towards decree comideiion. and NPA): 4: railing: 0; Non

performance. Classes for which a 0 grade was earned are not

included in NPA calculation, Giadcs oanied in ihc I.L.M. (Master of

l.aws) program were; A=4,00. 13=3.00. C=2,()(l. D=I.OO. ]-=().()(). N o

17- distinctions are given,

Symhiils Fullnvviiig C.'ouisc N'unihcrs

C - certificate credit

F. - on Duhith campus, registration in Continuing Fducatioii. or

on Twin Cities campus, an M13A course

G - honors course for extra credit

i I - honors course

J — evening MBA couise I'or extra credit

K - evening MB,A course by inclepeudent study

L - lionors course by independent study

M - e.xtra cretlit by independent study

0 — evening MI3A extra credit by independent study

R - honors c.xira credit by indepcmlcnt study

S - semester registration (pre 1999)

T- semester honors course (pre 1999)

U - special term course taken for c.vira credit

V - lionors and writing intensive

W- wriiing intensive

.\ - extra credil

V - independent study

Z - special term registration

Second Language Prollciency means demonstrated intermediate

proficiency in reading, writing, li.siening. and speaking.

Degree vvith distinction indicates graduation with high CPA: degree

with lionors (laude) indicates completion of special honors program.

For more information see: w vvw.umn.edu

Campuv Records ntTtcf tocaltnni:

UnUeisily uf Minnesi'ta, Crookslmi

170 (>»en Hull

Cro.il.sli.n. MN 5s7t(>-.'iO(ll

|2IS);S1-S3.0I

Dcpl ofltdiic tnsl cd:

Uniêrsilv ut'Minnc'ioia. IJutuili

IS4 [l.irt.md .'Vdmiiii.vaalioii liu'ildin^

tliitiidi, MN 55Ki;-.V(itt

(:iHl7:fi-8noO

tX'in ot'llduc Insi cd; (i(l27.SH

Univcfiiu oi'MiniKôia. Morrir-

212 Bctimter Hall

Morris, MNSf>:t<7-2t32

(320138')-<>0S0

IVpl ol Tduc tnsr cd: (412389

200 Trascr ttjil

or

.Miniie.ipolis, MN .SJ-ISS

|M2)()2-1-It1t

nop! of lidiir tnsr til: 0039(i9

IJiijsvrvio orMiniicsolj. I "in Cilics

130 Vollo- fl,itl

or

(30 Wesi QO,,!. si.ywp>

•SI, Puiil, MN ?5t08

Mmncopolis, MN 35455

(til2)62J-llll

(C12)r.24.11ll

t he t.!r>i\ersitv ol'.Mmncsow, VVavjcn campus

closed in (992, For inlornialion on W'a.«eta

.siuJcni innstripLs, coiitoel ihc .Si, I'diil oirite.

ISLEY, M

ICHELLE M

D00046097 P

AG

E 2

1

UNIVERSITY OF MINNESOTA

Tvin Cities Campus

Office of the Registrar

Student Services Cenler-St. Paul

Offic

e of Enro

lled

Siiid

eni 'Ser

vice

sno C

offey

Hal

l1420 E

ckle

s Ave

nue

St. P

aul. M

N 5

5108-6

054

RETURN SERVICE

REQUESTED

¥

nfMi V Qowi:;*

02 1A

$ 00-32®

000432-4525

FEB01 2006

MAILED FROM 2IPC0DE 5541 4

V/

T S : 0< V::r - "

L G M >••: T* 1-1 •1 S & ."i: O 4

ISLEY, M

ICHELLE M

D00046097 P

AG

E 2

2

y^HenithRECEIVED

JAN 3 0 2006DEPARTMENT OF HE^HHEALTH PROFESSIONS 5TO: Post Graduate Training Program Director

iVvc QV^VO \JJJ^\\JWS\VU. "D(if>corVw\mV o9FACILITY NAME ' ^

1VD6 UpV fUv DV Y ccuss h-txil

0^ 42>'2-\0ADDRESS

Co\\jj/VubU^

RE: Verification/Evaluatton of Training

I am a pplying for a license to practice medicine in the state of Washington and before my application can be reviewed, a

verification and evaluation of the post-graduate training performed in your institution is required. I am authorizing the

release of and would appreciate you providing the information and returning it, at your earliest convenience, directly to the

address shown below. All questions must be answered.

APPLICANT [PRINT OR TYPE) NA.. 'Xs\c^

SIGNATURE OF APPLICANT L..4fV\ ^

from toBEGINNING DATE (MONTH & YE ARJ

giRTHDATE

Is or was engaged in postgraduate training in our program

ENDING DATE (MONTH S YEAR)

in the field of

2. At the time this individual was In training, was this program accredited through the Accreditation

Council for Graduate Medical Education, the Royal College of Physicians and Surgeons, or the

College of Family Physicians of Canada? ^ Yes • No

3. Was the participant ever restricted, suspended, terminated or requested to voluntarily resign his/her participa

tion in the program? D Yes ^Nor

If yes. please explain

Return to:

Medical Quality Assurance Commission

PO Box 47866

Olympia, WA 98504-7866

(360) 236-4785 (A-L)

(360) 236-4784 (M-Z)

(SEAL)

Signature

Title !»C O

Hospital The. OKin^wc. ImiVefSifPLEASE TYPE OR PRINT -I

Address Ufho/Y) IT. 5fin POCT IkU

_Mtoohus_._(D_H_-y3_y_o___Date / "2^0 "05

Telephone Cfam)24.v377.^

DOM 657-034 (REV 7/2004)


r J

State Medical Board of Ohio77 S. High St.. 17lh Floor • Columbus. OH 43215-6127 • (614)466-3934 • Wcb.siic: www,mcd.ohio.gov/

VERIFICATION OF LICENSURE

This is to verify that the records of the State Medical Board Of Ohio contain the

following information for the indicated licensee as of 1/27/2006:

Name: Mailing Address:

Date of Birth: Place of Birth:

Identification Information

Michelle Marie Isjey

09/27/1974Ellendale, ND

RECEIVED

FEB 0 3 2006

nPPARTMENT OF HEALTHH^HPRVESSIO^

School of Graduation:

Date of Graduation:University of Minnesota Medical School - Minneapolis05/11/02

License Information

Type of License: License Number:

How Issued:

Original Licensure Date: Expiration Date:

Status:

Doctor of Medicine

35 - 085199End USMLE10/15/200410/01/2006ACTIVE

Formal Disciplinary Action: No(If Formal Action is YES, see attached documents)

Debra L.Jones

CME and Renewal Officer

1 - DOH Licensee Health Professional ...


State Medical Board of Ohio77 S. High St.. 17th Floor • Colunibus. OH 43215-6127 • (614)466-3934 • Website; www.med.ohio.gov/

VERIFICATION OF LICENSURE

This is to verify that the records of the State Medical Board Of Ohio contain the

following information for the indicated licensee as of 1/27/2006:

Name:

Mailing Address:

Date of Birth:

Place of Birth:

Identification Information . AMichelle Marie Isiey

Ohio State University Hospital,Corporate Credentialing Ofc - Attn: Cindy Carey "O

Columbus, OH 43221

09/27/1974

Ellendale, NO

School of Graduation: Date of Graduation:

University of Minnesota Medical School - Minneapolis05/11/02

License Information

Type of License:License Number:How Issued:

Original Licensure Date:

Expiration Date:Status:

MD Training Certificate57 - 006487

09/27/200206/30/2005INACTIVE

Formal Disciplinary Action: No(If Formal Action is YES, see attached documents)

Debra L.Jones

CME and Renewal Officer


AMAAMERICAN

MEDICALASSOCIATION

AMA Physician Profile

Name and Mailing Address:

MICHELLE MARIE ISLEY MD

Primary Office Address:

SAME AS MAILING ADDRESS

Phone: UNKNOWN

Birlhdale: 09/27/1974

Birthplace: ELLENDALE, ND UNITED STATES OF AMERICA

Physiclan s Major Pruressional Activity: HOSPITAL BASED RESIDENTS - ALL YEARS

Practice Specialties Self Desi{;naled by the Physician*:

Primary Specialty: OBSTETRICS & GYNECOLOGY

Secondary Specialty: UNSPECIFIED

'Self-Designated Practice SpecialtiesfAreas of Practice (SDPS) listed on the AMA Physician Profile do not imply "recognition' or"endorsement" of any field of medical practice by the Association, nor does it imply, certification by a Member Medical Specialty Board ofthe American Board of Medical Specialties, or that the physician has been trained or has special competence to practice the SDPS.

AMA membership: MEMBER

All Information from this Point Forward is Provided by the Primary Source

Current and/or Historical Medical School:

UNIV OF MN MED SCH, MINNEAPOLIS MN 55455

Degree Awarded: Yes

Degree Year: 2002

UNIV OF MN-DULUTH SCH MED. DULUTH MN 55812

Degree Awarded: No

AMA Flics Cheeked 2/8/06 09:30:5 Profile for: Michelle Marie (sley MD

®2006 by the American Medical Association

Page I of 4

1 - DOH Licensee Health Professional Ho...


AMA AMERICAN jrV^

MEDICAL AASSOCIATION


Current and/or Mislorical Post Graduate Medical Trainine Programs Accredited by Ihe Accreditaiion Council for

Graduate Medical Education (ACGME):

Future training dales, as reported by the program, should be interpreted as "in progress" or "current" with projected date of completion. If the

training program indicates that train ing for a physician in a particular specially u-of not completed at their inst itution, the training segment will be

identified as "INCOMPLETE TRAINING".

institution: OH STATE UNIV HOSP

Specialty ; OBSTETRICS «& GYNECOLOGY

State: OHIO

07/2002 - 03/2006

(VERIFIED)

Note: If you have discrepant Inrormallon, pJcuse submit a Request for Investigation to the AMA so that we may verify the information with the

primary sourre(s). Sec the last page of this P ronie for instructions on how to report a data discrepancy.

Current and/or Historical Medical Licensure:

Jurisdiction

MP/

PC

Putc

Granted

Expiration

Date Status

License

Type

Last

Reported

OHIO MD 10/15/2004 10/01/2006 ACTIVE UNLIMITED 01/06/2006

OHIO MD 09/27/2002 06/30/2005 INACTIVE RESIDENT 11/03/2005

Note: M'hcn the specific month and day arc unknown, the dale will display the default vuluc of "01." Not all licensing boards

maintain or provide full dale values. Please contact the appropriate Jiccnsing board directly for this information.

ECFMG Certfication:

Applicant Number:

Note: The Educational Commission for Foreign Medical Graduates (ECFMG) applicant Idenliflcallon number docs not imply

current ECFMG ccrliflcaiion status. To verify ECFMG status, contact the ECFMG Ccrtidcation Verification Service in

writing at P.O. Box 13679, Philadelphia, PA 19101.

Federal Drug Enforcement Administration:

• Only the last three characters of active DEA niiniher(s) are displayed.

PEA Number * Schedule Expiration Date Last Reported

None Reported

Note: Many stales require their own controlled substances registration/license. Please check with your state

licensing authority for requirement information as the AMA does not ma intain this information.

AMA Files Checked 2/8/06 09:30:5' Profile for: Michelle Marie Isicy MD


Page 2 of 4


AMAAMERICAN

MEDICALASSOCIATION


Specialty Board Cer(ificalion(s)*:

Specialty Board Ccnificaiion(s) by one or more of the 24 boards recognized by ihe American Board of Medical Specialties

(ABMS) and the American Medical Associatio n (AMA) through the Liaison Committee on Specialty Boards, as reportedby the ABMS;

The AMA Physician Profile has been designated by the ABMS as an Official ABMS Display Agent of Member Board

Certification data. Therefore, the ABMS Board Certification information on the AMA Physician Profile is considered a

designated equivalent source in regard to crcdentialing standards set forth by accrediting bodies such as the Joint Commission

on the Accreditation of Healthcare Organizations (JCAHO) and National Committee for Quality Assurance (NCQA).

Certifying Board: TO DATE, THERE HAVE BEEN NO B OARD CERTIFICATIONS REPORTED.

Ccrlificale:

Certificate Type:

Duration Effective Expiration Occurrence Last RcDorled

Note; For certification dotes, a default value of "01" appears in the day or month Held If data were not provided to AMA. Please contact the

appropriate specialty board directly for this Information. (**) Indicates an expired certificate.

*1'his Information is proprietary data maintained in a copyrighted database compilation owned by (he American Board of Medical Specialties.

Copyright 2006 American Board of Medical Specialties. All right reserved.

Medlcare/Medlcaid Sanctionfs):

TO DATE, THERE HAVE BEEN NO SUCH SANCTIONS REPORTED TO THE AMA B Y THE DEPARTMENTOF HEALTH AND HUMAN SERVICES.

Other Federal Sanction(s):

TO DATE, THERE HAVE BEEN NO FEDERAL SANCTIONS REPORTED TO THE AMA BY ANY BRANCH OF

THE US MILITARY, THE VETERAN'S ADMINSTRATION OR THE US PUBLIC HEALTH SERVICE.

AMA Files Cheeked 2/8/06 09:30:51 Profile for: Michelle Marie Islcy MD Page 3 of 4



AMAAMERICAN

MEDICAL \ASSOCIATION


Addilional Information:

TO DATIZ, THERIZ IS NO ADDITIONAL INFORMATION FOR THIS PHYSICIAN ON FILE.

I'hc conlcnl of (he AMA Physician Profile is intended to assist with crcdcntiaiing. Appropriate use of the AMA Physician Moslcrnie data

contained on this Profile by an organlznlion would meet the primary source vcriricalion requirements of the Joint Commission on Accreditation

of flealthcarc Organizations (JCAIIO) and the American Accreditation ilcallhCarc Commission/URAC. The Physician Masterflle meets the

National Committee for Quality Assurance (NCQA) standards for verification of medical education, post graduate medical training, board

certification, DtA status, and Medicarc/Medicaid sanctions.

If you note any discrepancies, please log onto our web si te (htip://www.ama-assn.org/go/amapronics) and go to the order detail page, select the D

following the physician's name and enter the da ta in question. Or you can mark the is sues on a copy of the profile and mail or fax to:

Division of Database Products and Licensing

Attn: Crcdcntiaiing Products

515 N. State Street

Chicago, IL 60610

800- 665-28823l2 464-5900 (rax)

[f you have queslions or need additional information, please call the AMA Profile Service customer support line

at 8 00-665-2882.

AMA Files Cheeked 2/8/06 09:30:51 Profile for: Michelle Marie Isley MD Page 4 of 4



Page 1 o f i

The Federation of State Medical Boardsof the United States, IncPO Box 619850

Dallas, Texas 75261-9850Telephone: (817)868-4000FAX (817)868-4099

BOARD ACTION CLEARANCE REPORTFebruary 08, 2006

Alln: Blake Maresh, Exec Dir.Washington Quality Med Assur310 Israel Road SB

PO Box 47860

Tumwater, WA 98501

Re: Board Action Query Dated: February 08, 2006Your Reference Number:FSMB Batch Number: BQ1220737

The following is a report of the search results from the Board Action Data Bank as of February 08, 2006 for practitioners subrabove-referenced batch for which NO board actions were identified.

Practitioners Cleared with No Actions as of February 08, 2006

Item Name DOB School Yr/Grad

Isley, Michelle 09/27/1974 024020 2002

https://secure.fsmb.org/baweb/repoi1s/hcrlOE2,him 02/08/2006


Application File_527242_pdf-r.pdf redacted on: 6/9/2015 12:27

Redaction Summary ( 8 redactions )

2 Privilege / Exemption reasons used:

1 -- "DOH Licensee Health Professional Home Address and/or Phone - RCW 42.56.350(2)" ( 6 instances )

2 -- "DOH Licensee Social Security Number - RCW 42.56.350(1)" ( 2 instances )

Redacted pages:

Page 2, DOH Licensee Health Professional Home Address and/or Phone - RCW 42.56.350(2), 2 instancesPage 2, DOH Licensee Social Security Number - RCW 42.56.350(1), 1 instancePage 7, DOH Licensee Health Professional Home Address and/or Phone - RCW 42.56.350(2), 2 instancesPage 7, DOH Licensee Social Security Number - RCW 42.56.350(1), 1 instancePage 24, DOH Licensee Health Professional Home Address and/or Phone - RCW 42.56.350(2), 1 instancePage 26, DOH Licensee Health Professional Home Address and/or Phone - RCW 42.56.350(2), 1 instance

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Documents