Pediatric Resident and Fellow Processing of Patient Death Interview Contact Information

Thank you for your willingness to be contacted for a possible interview. The interview will take place two weeks after the death of a patient you have worked with. Please complete the below information.

New Item

* 1. My name is:

2. My email address is:

* 3. I am a:

1st Year Resident
2nd Year Resident
3rd Year Resident
ED Fellow
PICU Fellow
NICU Fellow