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Graduate Medical Education Concern Form

This form is offered as a confidential reporting option to our LECOM Residents and Fellows in our Graduate Medical Education programs. These reports go directly to the Designated Institutional Official and will be reviewed and routed to the appropriate party. You may report anonymously, include non-identifiable contact information, or include your name and contact information for follow-up. While all reports are encouraged and appreciated, the inclusion of contact information will allow us to potentially obtain supplemental information to adequately investigate or mediate the reported concern(s).

Please indicate if you would like the Designated Institutional Official to follow-up with you?(Required)
Name

Graduate Medical Education

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