College of pharmacy College of pharmacy

Internship Daily Time Record Internship Daily Time Record

________________________________________ ________________________________________
Name of Intern: Name of Intern:

Name of Pharmaceutical establishment: Name of Pharmaceutical establishment:

___________________________________________________
Address :
Address :

For the Month of:

For the Month of:

============================================= ==============================================
DATE A.M. P.M.
DATE A.M. P.M. Arrival Departure Arrival Departure Hours Minutes
Arrival Departure Arrival Departure Hours Minutes
1
1
2 2
3 3
4 4
5 5
6 6
7 7
8 8
9 9
10 10
11 11
12 12
13 13
14 14
15 15
16 16
17 17
18 18
19 19
20 20
21 21
22 22
23 23
24 24
25 25
26 26
27 27
28 28
29 29
30 30
31 31
TOTAL= hrs. TOTAL= hrs.
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Hospital Pharmacy Hospital Pharmacy
Community Pharmacy Community Pharmacy
Manufacturing Pharmacy ____________________________ Manufacturing Pharmacy ____ ____________________
Intern’s Signature above printed name Intern’s Signature above printed name

Prof. Tax No.: _______________ Prof. Tax No.: ____________

Date Issued : _____________ D ate Issued: ____________
Reg. No. : ____________ Reg. No. ____________.
Pharmacist ‘s signature above printed name
Pharmacist ‘s signature above printed name

Certified: Noted:

Certified: Noted: Socorro B.Gutierrez.MSPh

President of the Firm Dean

Socorro B.Gutierrez.MSPh ------------------------------------------------------------------------------

President of the Firm Dean

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