PARIM is the Professional Association of Residents and Interns of Manitoba
Home Call Conversion Form
Please use the form below to submit your Home Call Conversion requests to PARIM.
First Name *
Last Name *
WRHA Employee Number *
Your E-mail Address *
Name of Service *
Location / Site *
Date of conversion (DD-MM-YYYY) *
Time in *
Time out *
Type of service performed (check all that apply)
ward patient assessment
emergency department consult
surgical/anaesthesia duties
diagnostic imaging
other
If Other, please specify
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