_________________ROTATION _________________ROTATION

Make-up / Clearance Slip Make-up / Clearance Slip

Name:__________________________________________________________________________ Name:__________________________________________________________________________
Date of Rotation:__________________________________________________________________ Date of Rotation:__________________________________________________________________

List of Deficiencies (LATE/ ABSENT) List of Deficiencies (LATE/ ABSENT)

Date Equivalent Date & Time of Resident-in- Rotation Coordinator Date Equivalent Date & Time of Resident-in- Rotation Coordinator
(Duty Status) Make-up Make-up charge Signature Signature (Duty Status) Make-up Make-up charge Signature Signature

OTHERS: OTHERS:

Clerks copy Admin Assistants copy

- - - - - - - - -- - - - - - - - -- - - - - - - - -- - - - - - - - - - - - - - - - - -- - - - - - - - -- - - - - - - - -- - - - - - - - -

_________________ROTATION _________________ROTATION
Make-up / Clearance Slip Make-up / Clearance Slip
Name:__________________________________________________________________________ Name:__________________________________________________________________________
Date of Rotation:__________________________________________________________________ Date of Rotation:__________________________________________________________________

List of Deficiencies (LATE/ ABSENT) List of Deficiencies (LATE/ ABSENT)

Date Equivalent Date & Time of Resident-in- Rotation Coordinator Date Equivalent Date & Time of Resident-in- Rotation Coordinator
(Duty Status) Make-up Make-up charge Signature Signature (Duty Status) Make-up Make-up charge Signature Signature

OTHERS: OTHERS:

Rotation Coordinators copy Resident -Clerks Monitors copy