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  • Scan May 19, 2020

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    Diana Novac
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    This document is a request form for approval to complete a clinical rotation in a specific medical specialty and department at a hospital. The applicant provides their personal details such as name and resident code. They are requesting approval to complete their clinical training in the specified specialty during the listed time period in the requested clinical section/department under the supervision of the named professor, conference, or chief resident. The applicant signs and dates the bottom of the form.

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    This document is a request form for approval to complete a clinical rotation in a specific medical specialty and department at a hospital. The applicant provides their personal details such as name and resident code. They are requesting approval to complete their clinical training in the specified specialty during the listed time period in the requested clinical section/department under the supervision of the named professor, conference, or chief resident. The applicant signs and dates the bottom of the form.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    Download as pdf or txt
    8 views1 page

    Scan May 19, 2020

    Uploaded by

    Diana Novac
    This document is a request form for approval to complete a clinical rotation in a specific medical specialty and department at a hospital. The applicant provides their personal details such as name and resident code. They are requesting approval to complete their clinical training in the specified specialty during the listed time period in the requested clinical section/department under the supervision of the named professor, conference, or chief resident. The applicant signs and dates the bottom of the form.

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    of 1

    DE ACORD

    CERERE

    Subsemnatul(a) ................ .......... ... .. .. .... .. .. .. .. .... ..... ..... .. ..... ... .... ......... ................ . .

    cod rezident ......................................... .. ... ... ... ....... rezident/ specialist in specialitatea

    (specialitatea fn care desfa$oara pregatirea)

    va rog sa binevoiti a-mi aproba efectuarea stagiului ................... ... ......................... .. ... ..

    ······ ············ ····· ···· ············ ··· ·· ········· ··········· ··········· ······· ···· ··············· ·· ············· ·· din

    curricula de pregatire in specialitate, in perioada .......... ...................... ........ ...... ....... ..... ,

    •1n t · / sect,a
    sect1a · · - ... .. ....... .. ......... ...... ......... ............ .................. .... .. ..... .. .. ... .... ..
    t · c11n1ca

    pe care o conduce\i.

    Data Semnatura

    Domnului prof. univ. / conf. univ. / ~ef lucr. dr............................. ...................... ... .. ..

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