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MSH Adult/Peds Moonlight Submission Form
To get paid, please submit your Mount Sinai Hospital Adult and Peds Moonlighting information on this form.

If you have any issues getting paid for MSH moonlighting your contact person is: marisol.xelo@mountsinai.org

For Mount Sinai Queens (MSQ) moonlighting submissions DO NOT USE THIS FORM, please e-mail: donna.smithjordon@mountsinai.org

Untitled title
Name:
Your answer
Life Number:
Your answer
Date of Your Moonlighting Shift:
(If Overnight: Date Shift Started)
MM
/
DD
/
YYYY
Shift Start Time:
Time
:
Shift End Time:
Time
:
Shift Duration in Hours
Your answer
Location:
Payment Preference:
Submit
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