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Resident Rotation Change Form

Requests for schedule changes must be submitted at least 30 days prior to the rotation affected. Requests submitted after 30 days will not be approved.

Resident name:


Reason for Change:


Previous Rotation:


Previous Rotation - Month/Year:


Previous Attending:


Newly Requested Rotation:


New Rotation - Month/Year:


Newly Requested Attending:


By submitting this form you are submitting your digital signature and will be held responsible for the form contents.

 

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