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UNIVERSITY of SANTO TOMAS

Faculty of Pharmacy
Espaa, Manila
DEPARTMENT of MEDICAL TECHNOLOGY

INTERNSHIP PROGRAM - ACADEMIC YEAR _____________

INDIVIDUAL MONTHLY CLINICAL INTERNSHIP EXPERIENCE REPORT


Name of Intern: __________________________________________
Hospital Assignment: _____________________________________
Month of _________________________________________
Medical Technology Internship (please encircle):

Lab Section/ Inclusive Dates

(1)

(2)

Activities/Tasks/Responsibilities

Problem(s) Encountered

Action(s) Taken

Personal Reflection(s)

AA:10-02-FO07

UNIVERSITY of SANTO TOMAS


Faculty of Pharmacy
Espaa, Manila
DEPARTMENT of MEDICAL TECHNOLOGY

INTERNSHIP PROGRAM - ACADEMIC YEAR _____________

MONTHLY SUMMARY OF CLINICAL INTERNSHIP EXPERIENCE REPORT


Name of Interns:

Group Leader: _____________________________________

_____________________________________

_____________________________________

_____________________________________

_____________________________________

_____________________________________

_____________________________________

_____________________________________

_____________________________________

Hospital Assignment: _______________________________________________


Month of _________________________________________________________
Medical Technology Internship (please encircle):
Lab Section/ Inclusive Dates

(1)

(2)

Activities/Tasks/Responsibilities

Problem(s) Encountered

Prepared by:

Noted by:

Group Leader
Hospital Assignment

(Name of Clinical Instructor) , RMT


Clinical Instructor

Action(s) Taken

Personal Reflection(s)

AA:10-02-FO07

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