Monthly Inpatient Schedule Requests
Monthly Inpatient Requests are due by the 15th of the month 4 months prior to the requested month (Jan 15th for May requests)
Name:
Service:
Gens
Cards
Heme/Onc
MICU
CCU
Day Float
ER
Mercy
Vac/Elective
Consults
Peds (Med/Peds)
Month Requested:
January
February
March
April
May
June
July
August
September
October
November
December
Your full (UCH) email address:
PREVIOUS Service:
Gens
Mercy Gens
Cards
CCU
Heme/Onc
MICU
MacNeal
Vac/Elective
Ambulatory/PCG
Consults
ER
Peds (MedPeds)
Service AFTER the requested month:
Gens
Mercy Gens
Cards
CCU
Heme/Onc
MICU
Vac/Elective
Ambulatory/PCG
Consult
ER
Peds (Med/Peds)
Last call day/MROC/Paid NF prior to the start of the month:
Jeopardy for the two weeks before the month requested?
Yes
No
Jeopardy for the two weeks after the month requested?
Yes
No
Please PRIORITIZE MONTHLY SCHEDULE REQUESTS and REASONS. We will do our
best to accomodate your requests, please provide enough information for us
to understand and properly triage.
Indicates Response Required