Outpatient Absence (Y-Week Clinics)
After notifying the Chief Resident On Call, you are required to complete this form for any absences from your scheduled Y-week clinic.  You are required to include the email of your supervising attending. Subspecialty clinic contact information can be located from the Important Links Document, and attached here Clinic Contact Sheet  
An email will be sent to your clinic mentor/supervisor notifying them of your absence. If you do not see the contact information for you clinic, please notify your Chief On Call
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Email *
Full Name *
Date(s) of Absence  *
MM
/
DD
/
YYYY
please specify half or full day *
Reason for Absence *
Valid Work Email of Clinic Mentor or Supervisor *
What rotation are you currently on?
A copy of your responses will be emailed to the address you provided.
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