Administrative Services Division of general internal medicine Administration Providing administrative services & support to our division, faculty, and staff. business-deal-handshake New Hire Form plane-take-off Travel Authorization Request video-player-laptop Marketing time-clock-hand-1 Coming Soon Leave Request Form Leave Request Form GIM Leave Request General Internal Medicine Faculty Leave Request Form. "*" indicates required fields Provider's Name* First Last Type of Leave* Vacation Sick Academic Leave December Personal Leave Administrative (UF approved only, i.e. Jury Duty) Clinic Closure (no leave time will be recorded) Clinic Swap (no leave time will be recorded) Leave Dates Requested*Please complete 1 form per date range or leave incident. Academic Leave Event and Location* Are you precepting on the requested days?* Yes No If precepting, specify dates/sessions.*(Example: 1/1/19 AM, 5/12/19 PM)Who is covering your EPIC in-basket?* Is this request?* 0-29 Days of Date(s) Requested 30-60 Days of Date(s) Requested 61+ Days of Date(s) Requested Is this an emergent request?*If this is an emergency, please give a brief description of the emergency in the comment section Yes No What is the date(s) of the makeup clinic(s)?*Are you able to accomodate patients bumped within +/- 2 weeks of original appointment date?*Makeup dates must be provided for non-emergent leave requests between 30-60 days if patient cannot be accommodated within 2 weeks of original appointment date. Yes No What is the date(s) of the makeup clinic(s)?*Comments*Completed By* Email us
Division of general internal medicine Administration Providing administrative services & support to our division, faculty, and staff.