Internal Medicine Resident Leave/Swap Request

Department of Internal Medicine Resident Request for Leave/Rotation Swap

Resident Request Information
*
*
Requested For

*
*
Time Away
Swap Rotations
Clinic
Is Clinic Scheduling involved in time away or swap?

*
Clinic

Signatures: The text entered will serve as your electronic signature. Please check with the correct program administrator to provide additional required signatures.
*
*
*
*