Inpatient & MROC Block Schedule Requests: 2023-2024
This form is for the 2023-2024 academic year (starting block 1A on June 24, 2023).

This is the form to submit individual day off requests for Internal Medicine inpatient rotations. If you have more than one request, please submit multiple times.

The MROC requests apply only to weekday MROCs. Please refer to the weekend float schedule to see the weekend assignments. 

If you are submitting a clinic request, please use the clinic request form. You do not need to submit requests for consult blocks, please coordinate with your fellows. 

To ensure your request is appropriate, please refer to the Internal Medicine Service Rules before submitting. http://medchiefs.bsd.uchicago.edu/administrative/service-rules/
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Full Name *
PGY Level *
Block - Note different dates for Residents and Interns *
Date Requesting Off *
Do NOT enter a date that is not included in the time frame above.  If you do, it will not be considered. PLEASE DO A SEPARATE REQUEST for EACH 24 HOUR period you are requesting off.
MM
/
DD
/
YYYY
Are you making a request for Inpatient or MROC/MIOC? *
What service are you on for this requested day?
Clear selection
Reason for your request *
This will help prioritize your request. DO NOT PUT DATE RANGES HERE. Please fill out a separate form for EACH DATE. If you do not do this, it will not input correctly into our system and there may be an error!
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