Locum Coverage Request

Need a vacation?  We will try our best to find a locum for you!  Please share your contact information and dates of required coverage below.

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* 1. Please share your contact information below:

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* 2. Please share the dates when you require coverage?

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* 3. Are you able to provide accommodation and or a vehicle, or other perks?  Please describe:

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* 4. Please provide specifics on coverage needed (i.e. Hospital, ER, extended care, etc).

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* 5. What type of EMR is in place in your practice?

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* 6. Thank you for your request.  Please enter any additional information you wish to share here:

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