Children’s University Medical Group (CUMG)

Provider Forms

CUMG Member Notification Form

This form should be used when a new CUMG provider will practice only at Seattle Children's or when a CUMG or UWP provider changes status as it relates to work at Seattle Children's. Download the CUMG Member Notification Form (PDF).

Employment Verification

For employment verification, please email us the request and authorization. An original signature is required for all verification requests.

License Renewal Reimbursements

CUMG reimburses for medical and DEA license renewals for members, associates and some limited associates with administrator approval. The policies vary between academic departments. Questions about whether renewals are covered should be directed to your UW department administrator. You may also want to review the CUMG Administrative P&P: License Renewal Reimbursements Policy (PDF).

It is the professional responsibility of each CUMG member to keep his or her medical license current. CUMG is responsible for reimbursement of fees paid in accordance with departmental policies.

Reimbursement process

  1. Pay out-of-pocket to renew your license.
  2. Complete the new online License Reimbursement Request Form and submit it to CUMG Payroll with proof of payment (cancelled check, online receipt, credit card/bank statement, etc.).
  3. Reimbursements received with approval by the 18th of the month will be processed with the regular monthly payroll. Payments will be paid either through direct deposit or, if this is not on file, a live check mailed to your home. We strongly recommend setting up direct deposit for these payments.
  4. Reimbursement is identified on your pay stub in the “Deductions” section and will appear as a negative amount.