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  • Resident Vacation Form

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    Vlad
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    The document is a resident vacation/conference request form that contains fields for a resident to fill out such as their name, program, assigned service, location, duration of request, and signature lines for approval from the service director and home program director. It notes that additional forms must be completed by PGY1 internal medicine residents and provides a contact for any questions.

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    Resident Vacation Form

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    The document is a resident vacation/conference request form that contains fields for a resident to fill out such as their name, program, assigned service, location, duration of request, and signature lines for approval from the service director and home program director. It notes that additional forms must be completed by PGY1 internal medicine residents and provides a contact for any questions.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    17 views1 page

    Resident Vacation Form

    Uploaded by

    Vlad
    The document is a resident vacation/conference request form that contains fields for a resident to fill out such as their name, program, assigned service, location, duration of request, and signature lines for approval from the service director and home program director. It notes that additional forms must be completed by PGY1 internal medicine residents and provides a contact for any questions.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    RESIDENT VACATION/CONFERENCE REQUEST FORM

    Note: If you are a PGY 1 Internal Medicine Resident, please complete an additional form located here:
    http://www.residentcalendar.com/dalhousieim/vacationrequest.php
    If you have any questions, please contact: DoMEducation@nshealth.ca

    Resident: ___________________________________

    Program: ___________________________________

    Service assigned to: __________________________

    Location: ___________________________________

    Duration of request: FROM _____________________________ TO __________________________________

    Date request submitted: _____________________________ Date Approved: ___________________________

    Signature Service (See attached list):____________________________________________________________

    Date submitted to Home Program: _______________________ Date Approved: _________________________

    Signature Home Program Director: _____________________________________________________________

    Copies should be retained by all those who sign for record keeping purposes.

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