Form Name:	Healthcare Network Break Glass Form
Completed By:	House Officer
Used When:	Completed by incoming House Officers in programs that rotate to LSU Healthcare Network facilities.
Purpose:	Acknowledgement of the LSU Healthcare Network Break Glass Policy.
Direct Questions To:	Sara Blakemore
Form Link:	Auto-populated via Newhire Documents BreakGlassForm.pdf

Instructions for Completing Form

This form is completed automatically as part of the online Newhire Documents process. It is included in the Newhire Packet that is submitted to the GME Office.

Other Info

See LSU Healthcare Network Break Glass Policy

Places This Form is Referenced

Page:

Healthcare Network Break Glass Form (Forms & Documents)

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