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MOONLIGHTING ACTIVITIES IN WHICH I ENGAGE INCLUDING BUT NOT LIMITED TO WORK HOURS, NATURE AND SCOPE OF DUTIES AND PERFORMANCE THEREOF, AND I HEREBY CONSENT TO THE RELEASE OF SUCH INFOMRATION. I HAVE READ AND UNDERSTAND THAT ALL DUTY HOUR LIMITATIONS APPLY AS DESCRIBED IN THE UIHC MOONLIGHTING POLICY AND PROCEDURES FOR HOUSE STAFF PHYSICIANS AND DENTISTS; MY FAILURE TO ADHERE TO THIS POLICY AND THE PROCEDURES OUTLINED WITHIN IT CAN BE GROUNDS TO REVOKE APPROVAL TO MOONLIGHT OR GROUNDS FOR MY IMME.

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