Full Name: MD/DO Degree (Medical School & Graduation Year): Residency Program (Specialty, Institution & Completion Year): Board Certification(s) (Internal Medicine / Family Medicine / Emergency Medicine / Geriatrics – Include Status & Expiration): Active California Physician License (License # & Expiration Date): DEA Registration (Number & Expiration Date): California Controlled Substance (CDS) Registration (If Applicable): Total Years of Clinical Physician Experience: Years of Geriatric / Senior Care Experience: Describe your experience providing comprehensive primary care to medically complex geriatric patients: Describe your experience working within an Interdisciplinary Team (IDT) or collaborative care model: Describe your experience managing patients across hospitals, skilled nursing facilities, and long-term care settings: Describe your experience with value-based care, PACE, Managed Care, Medicare Advantage, or similar population health models: Do you currently supervise, mentor, or collaborate with Nurse Practitioners, Physician Assistants, or other clinical providers? Motivation / Reason for Relocation (if not local): Motivation / Reason for Interest in this Position: Contact Number: Email ID: LinkedIn Profile URL: Current Location (City, State): Full Address (Street, City, State, ZIP Code): Notice Period / Earliest Available Start Date: Current Work Authorization Status: Expected Salary: Are you able to relocate on your own (if required) and work onsite in Elk Grove, California?