Block Swap Form:Part A

Block Swap Form: Part A

Please complete this form to swap a block with another resident or intern. Block swaps must be submitted 45 days prior to rotation.
  • Coverage

  • Please list covering resident's/intern's name
  • Please list the following: location, team, and call of covering resident/intern (e.g. HAC East 3 Intern B Day Off)
  • Payback

  • Swap Policy

Swap Policy
  • This will serve as your electronic signature
  • The resident/intern you are swapping with must submit a Block Swap Form: Part B