Page 131 - 2019 Info to Resident Applicants
P. 131
UPMC Medical Education
Obstetrics and Gynecology Residency Training Program
Right of Conscience Objection for Abortion or Sterilization Procedures
I, _______________________________________ (print name) do not wish to participate in
the following procedures:
Check all boxes that apply:
□ perform abortion procedures □ perform sterilization procedures.
□ participate in abortion procedures □ participate in sterilization procedures.
□ cooperate in abortion procedures □ cooperate in sterilization procedures.
My objection(s) as indicated above is/are based upon the following:
This form must be signed and returned to the Residency Program Director’s Office.
Signature of Requestor Date
Family Planning Division Designated Reviewer Date
Residency Program Reviewer Date
