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For use by members of the Department of Family Medicine: Please use the box below to describe a microaggression or discriminatory behavior that you experienced or witnessed. Tracking the frequency of these events is useful, even if you do not desire specific action to be taken in response to your report. Responses are reviewed monthly by the Diversity and Inclusion Committee (DIC); the report is anonymous unless you choose to include your identity. If deemed appropriate based on trends, the DIC will escalate concerns while maintaining anonymity (e.g., to Residency Leadership Group, off-service rotation director, etc).
Other avenues for support:
- For same-day consultation, page PIC 9985 Fam Med Diversity Inclusion
- For a response within a few days, email the Diversity and Inclusion Committee at
CLFMDiversityandInclusionCommittee@hscmail.mcc.virginia.edu
(your email will be confidential to the DIC but not anonymous).
Do you wish any action to be taken on the basis of this report? (the DIC may still take action in general in response to trends from multiple reports)
Yes
No
I don't know
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