Call Switch Request Form

Name * Required
The requested call switch is less than 48 hours from the time of this request. * Required
If the answer is yes, you may not complete this form online. Please contact the Program Coordinator to complete a paper form before switch can be approved.
The call switch will not create a violation of ACGME Program Requirements * Required
VI.F.7. Maximum In-House On-Call Frequency Residents must be scheduled for in-house call no more frequently than every third night (when averaged over a four-week period). (Core)
Resident providing post-call coverage, chief resident, attendings on call both days, and attendings whose services are affected by post call coverage have ALL BEEN NOTIFIED AND AGREE WITH CHANGE. * Required
Resident is assuming responsibility to notify all affected parties PRIOR TO online request.
Date that I am currently scheduled for call * Required
Resident who will be on call for me instead on above date * Required
New call date that I will be assuming * Required

UAMS College of MedicineUniversity of Arkansas for Medical Sciences

Mailing Address: 4301 West Markham Street, Little Rock, AR 72205