Inpatient / Outpatient Sequence Preference Form

University of Illinois at Chicago College of Medicine
Department of Medicine

Internal Medicine
Inpatient / Outpatient Sequence
Preference Form

The Internal medicine rotation is a combined inpatient and outpatient experience in the third year. There are 3 tracks available in this rotation:

The first track is 4 weeks of outpatient followed by 8 weeks of inpatient.
The second track is 4 weeks of inpatient, 4 weeks of outpatient, and finishing with 4 weeks of inpatient.
The third track is 8 weeks of inpatient ward medicine followed by 4 weeks of outpatient medicine.

We would like to know your preference for these tracks. We will try to accommodate your choice when possible. Please rank your preferences in first, second and third order and fill out and submit the track preference form. For more information regarding the course, go back to the main page. For specific information regarding the ambulatory sites, go the Site Guide. Thank you.

First Name

Last Name:

Day phone Evening phone

My Medicine clerkship begins in

First Preference TRACK 1 TRACK 2 TRACK 3

Second Preference TRACK 1 TRACK 2 TRACK 3

Third Preference TRACK 1 TRACK 2 TRACK 3

Submit your completed preference form by entering your name and checking the checkbox to the left of your name .

First Preference	TRACK 1 TRACK 2 TRACK 3
Second Preference	TRACK 1 TRACK 2 TRACK 3
Third Preference	TRACK 1 TRACK 2 TRACK 3

When ready, check this box Then press here: