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BSN CLINICAL WEEKLY TIME LOG

STUDENT NAME _______________________________________________DATE ______________

FAMILY INITIALS (only) __________________ COURSE NUMBER ______________________

The following documentation accurately reflects my clinical hours and activities for the week indicated. Be sure to follow HIPAA guidelines when completing this form DATE TIME SPENT ACTIVITY(s)

Total Hours This Week ________________________________

Cumulative Hours to Date ___________________________________

Faculty Signature ______________________________________Date ______________________

The original copies of this form must be submitted to your faculty member at the end of this course. All documentation will be maintained at your campus. Copies should be made for your personal records.

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