Physician Schedule Change Form

The ad hoc form is to be used by all faculty members to request changes to their clinic schedules. The criteria for submitting the form is as follows, all vacation/personal requests need to have a minimum of 90 days’ notice, Conferences and Inpatient Service requests need to have a minimum of 60 days’ notice. If your request does not meet the defined criteria please work with your division chief to accommodate your request. Please be advised that your patients will not be moved and will be covered by a colleague.