Disciplinary Action Form - Texas Tech University Health - ttuhsc 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the 'Name of Resident / PGY Level' at the top of the form. This identifies the individual involved in the disciplinary action.
3. Next, specify the 'Campus / Department' where the resident is assigned. This helps contextualize the intervention.
4. In the 'TYPE OF INTERVENTION' section, circle one of the options: Observation or Probation, depending on the nature of the action being taken.
5. For 'PRIOR INTERVENTION', indicate whether there has been a previous intervention by circling 'Yes' or 'No'. If yes, provide details in the space provided.
6. Fill in the 'EFFECTIVE DATES OF ACTION', including both start and end dates for clarity on when this intervention will take place.
7. Attach any necessary documentation that supports this disciplinary action as indicated in the form.
8. Finally, ensure that all required signatures are obtained from relevant authorities such as Program Director and Department Chair before submission.

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