Inpatient Absence

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Inpatient Absence

After notifying the chief resident on call, you are required to complete this form for any absences from your scheduled inpatient shift (this includes any night coverage you have been assigned to). An email will be sent to your attending/supervisor notifying them of your absence.

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* Indicates required question

Email *

Your email

Full Name *

Your answer

Date(s) of Absence *

Your answer

Reason for Absence *

Your answer

Work Email of Clinic/Rotation Attending or Supervisor (or Chief Resident if on nights) *

Your answer

What rotation are you currently on?

Your answer

A copy of your responses will be emailed to the address you provided.

Submit

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