Schedule Change Request Form

							                          Schedule Change Request Form:

          o Please describe the requested trade:



          o What service is the person covering you on:



          o What clinic days are affected:



          o What alternate coverage is affected:



          o If working overnight, whether either person will have clinical duties
            the following day:



          o Will AM report, EBM conferences be affected:



Please be sure to have all people involved in this trade send confirmatory emails
to Wood or Cheryl agreeing to the trade. Thank you.