Patients: 301.790.8000


TDD: 240.469.6013



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ABOUT

LEAVE OF ABSENCE

Below you'll find the form needed to apply for Leave of Absence. Please complete the form with as much detailed information as possible. When finished, click on submit and our team will begin processing your request as soon as we can.

Leave of Absence Request Form

Team Memember Information

Leave of Absence Questionnaire

First Date of Leave *
Approximate End Date *

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11116 Medical Campus Road
Hagerstown, MD 21742

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Patients: 301-790-8000
TDD: 240-469-6013



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