Mistreatment Form

All reports submitted through these mechanisms will be received by the Associate Dean for Student Affairs. All concerns will be reviewed with the Vice Dean for Undergraduate Medical Education on a monthly basis and trends will be monitored. The individual mistreatment incidents as well as trends will be brought to the attention of the Vice Dean for Faculty Affairs (if faculty involved) or Associate Dean for GME (if resident involved), as well as the appropriate Chair or Program Director, or appropriate administrator at the clinical site. The responsible supervisor will have ten working days to initiate a response and communicate this to the Associate Dean for Student Affairs.

Incidents submitted through this form can be made anonymously. Note however, that if you choose to remain anonymous, UofL is limited in its ability to investigate and respond. The preference is for all reports to include contact information such that follow up can occur.

If you require an immediate emergency response to protect your safety or the safety of others, notify law enforcement authorities immediately.

The below list of behaviors is based on the Association of American Medical Colleges annual Graduation Questionnaire regarding mistreatment. Please indicate which category best describes the event you are reporting? Select as many as apply.*