NOTIFICATION of LEAVE

NOTIFICATION of LEAVE FORM

Please complete all details below:

N.B: Please use this form ONLY if you will be away for more than THREE (3) working days!

You will receive EMAIL confirmation once your leave has been confirmed.

Please make a note of your handover partner when notifying CSMP of your intended leave.

Your leave dates will be publicly available on the Practice's public website, as well as whom your patients are to see in your absence.

EVENT	Away FROM:	Returning ON:	Locum GP?
Dr Madhuri Jiwane AWAY!	17-02-2025	23-02-2025	Dr Janet McLEARIE (M, T, W, Th)
Dr Janet McLearie AWAY!	11-03-2025	16-03-2025	NO LOCUM
Dr Ben Tong AWAY!	05-04-2025	20-04-2025	Dr Ran LIU (M, T, W, F)
Dr Sean Kristoffersen AWAY!	17-04-2025	27-04-2025	Dr Eddie RICE (M, T, Th, F)
Dr Janet McLearie AWAY!	22-04-2025	27-04-2025	NO LOCUM

Surname

Name

Submission Date

FIRST Day AWAY?

LAST Day AWAY?

First WORKING DAY back at CSMP?

While I'm away, my correspondence and results will be checked by:

If there are any URGENT (i.e. critical care, non-ED admission) patient requests, will you be contactable?

Have you discussed any COMPLEX care patients with your handover partner?

Healthlink EDI: churstmp

280 Church St, Newtown 2042 NSW