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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
ISLEY, MICHELLE MD00046097 PAGE 3
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
ISLEY, MICHELLE MD00046097 PAGE 4
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PHYSICIAN & SURGEON
REVENUE SECTION
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PRINT NAME
RETURN THIS PORTION
WITH CHECK & APPLICATION \:- J: iov\j
laSSQ'^ODaD ODEBt
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ISLEY, M
ICHELLE M
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ISLEY, M
ICHELLE M
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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...
ISLEY, MICHELLE MD00046097 PAGE 7
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
ISLEY, MICHELLE MD00046097 PAGE 8
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 ^A.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
ISLEY, MICHELLE MD00046097 PAGE 9
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
ISLEY, MICHELLE MD00046097 PAGE 10
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
ISLEY, MICHELLE MD00046097 PAGE 11
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
ISLEY, MICHELLE MD00046097 PAGE 12
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
School of Medicine, 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
School of Medicine, 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 l^ints
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
THIS OFFICIAL UNIVERSITY TRANSCRIPT IS PRINTED ON SECURITY PAPER AND DOES NOT REQUIRE A RAISED SEAL
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
ISLEY, MICHELLE MD00046097 PAGE 15
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
is noted in parenthesis):
(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
meet course requirements
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
the sequence is complete
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 lii^i 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
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Miiiiit-apoiis, MN 55-155
(oi;)o:a-ii 11
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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
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02 1 A
$ 00-37^
000*3304391
JAN30 2006
MAILED FROM ZIP CODE 55012
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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 Cr^e 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
THIS OFFICIAL UNIVERSITY TRANSCRIPT IS PRINTED ON SECURITY PAPER AND DOES NOT REQUIRE A RAISED SEAL
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
is noted in parenthesis):
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
the sequence is complete
V —
assigned from Fall 1929 to Summer 1959 to indicate the student
canceled while doing passing work
7. - assigned from Fall 1929 to Summer 1959 to indicate the student
canceled while doing failing work
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
meet course requirements
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
canceled while doing passing work
Z - assigned from Fall 1929 to Summer 1959 to indicalc ihe student
canceled while doing failing work
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:
Uni^ersilv 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'MiniK^oia. 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)
ISLEY, MICHELLE MD00046097 PAGE 23
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 ...
ISLEY, MICHELLE MD00046097 PAGE 24
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
ISLEY, MICHELLE MD00046097 PAGE 25
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...
ISLEY, MICHELLE MD00046097 PAGE 26
AMA AMERICAN jrV^
MEDICAL AASSOCIATION
AMA Physician Profile
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
®2006 by the American Medical Association
Page 2 of 4
ISLEY, MICHELLE MD00046097 PAGE 27
AMAAMERICAN
MEDICALASSOCIATION
AMA Physician Profile
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
®2006 by the American Medical Association
ISLEY, MICHELLE MD00046097 PAGE 28
AMAAMERICAN
MEDICAL \ASSOCIATION
AMA Physician Profile
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
®2006 by the American Medical Association
ISLEY, MICHELLE MD00046097 PAGE 29
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
ISLEY, MICHELLE MD00046097 PAGE 30
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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