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Part 1 Burnout1 2Every day few times a weekend a week few times a monotone a month or less few times a yearNeverI deal very effectively with the problems of my patients6543210I feel I treat some patients

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Start by providing personal information such as your full name, address, and contact details.

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Specify the duration of your burnout leave, including the start and end dates.

04

Explain the reasons for your burnout, describing any specific work-related stressors or challenges.

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Part 1 - burnout is required by individuals who are experiencing burnout and need to take leave from work due to this condition.

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This form helps to document the reasons behind the burnout and serves as a formal request for leave.

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