Healthcare forms

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Iom medical certificate form OFFICE USE ONLY ? ? Registration Form Reference ID : Walk in ---------------------------------- Note: The provided information will be appeared on the Certificate. Please provide accurate information

Medical certificate for leave... FORM 4 MEDICAL CERTIFICATE FOR LEAVE OR EXTENSION OF LEAVE OR COMMUTATION OF LEAVE I, after careful personal examination of the case hereby certify that Sh.×SMT. Whose signature is attested given

Additional assistance in exami... ADDITIONAL ASSISTANCE IN EXAMINATIONS Massey University is able to provide assistance in examinations for students with a permanent impairment or other conditions such as injury, pregnancy or OOS

Guidelines for medical documen... District of Columbia Court of Appeals Committee on Admissions 430 E Street N.W. Room 123 Washington, D.C., 20001Request for District of Columbia Bar Examination Testing AccommodationsPhone: (202)

Wic medical documentation form... Form available at: http://health.hawaii.gov/wic. A. Patient ... Medical documentation valid for: 1 month 2 months 3 months 4 months 5 months.

Medical documents form Medical Documentation for WIC Formula and Approved WIC Foods for Women, Infants and ChildrenNEW YORK STATE DEPARTMENT OF HEALTH Division of NutritionWICWIC StampInstructions: Providers, please complete

Medical documents pdf form NEW YORK STATE DEPARTMENT OF HEALTH DIVISION OF NUTRITION Patient's Name Birth Date (MM/DD/YY) Birth Date: (MM/DD/YY) Parent/Caretaker's First and Last Name I authorize (Health Care Provider) to release

Medical document authorizing t... Medical Document Authorizing the use of Cannabis for Medical Purposes under the Access to Cannabis for Medical Purposes Regulations Help on accessing alternative formats, such as Portable Document

Medical documentation form for... 1 Georgia WIC Program Medical Documentation Form for WIC Special Formulas and WIC Foods Patient s First & Last Name: Date of Birth (MM/DD/BY): / / Parent/Caregiver s First & Last Name: 1. Qualifying

Fake medical documentation tem... Fake medical documentation template 847C55F2AD6A822D67E3E4C7134A4840Fake Medical Documentation TemplateThank you very much for downloading fake medical documentation template. As you may know, people

Cannimed medical document form Medical Document Toll free: 18557871577 Fax: 18442318929 info×cannimed.com www.cannimed.ca×1 Plant Technology Road Box 19A, RR×5 Saskatoon, SK S7K 3J8Medical Cannabis ProductsInstructions Physician:1.

How to get medical documents f... Hamad Medical Corporation Department of Medical Education - GME Office Photo RESIDENCY Programs Selection APPLICATION FORM - 2015 Intake Please read FAQs before completing the Application Form Type or Print in CAPITAL LETTERS. 1. Candidate Name as printed in passport First Middle Family Date of Birth // Place of Birth Nationality dd mm yyyy First Language/s English Arabic Spoken Written Gender Fluent Average Below Average Male Female Other Languages Civil Status Single Married 2. Passport Information Passport No Expiry Date // Resident in Qatar No Yes If Yes then provide QID/RP Expiry Date // 3. Contacts Details Contact Nos. in Qatar Home Mobile Fax Address in Qatar If resident in Qatar Street Name Country P. O. Box Address in Home Country E-mail Address In Case of Emergency person to contact next of kin Name Mailing Address Tel* No* Home Mobile E-mail Attachments Passport copy Qatar ID/Residency Permit 8 photos 1 of 5 4. Education and Qualifications Name of Medical College Country Name of academic degree awarded Date of Graduation // Language used in Medical College English Others 5. Internship/House Officer Appointment First year post graduate training Rotating Internship HMC Other Institution Straight Internship 1st year post graduate training Institution name Country Dates From // To // Medical license no Type Country Validity// 6. Post Graduate Training Country Describe clinical training/work Other academic qualifications i*e* Masters PhD Others Certificates Fellowship or Board Certifications Attachments Copy of medical degree certificate copy of internship certificate copy of medical license copy of clinical experience certificate or research copy of other academic qualification certificates 2 of 5 7. Current Clinical Post Position Title Institution/Hospital name 8. Matching choices Anesthesia Cardio Thoracic Surgery Family Medicine General Surgery Ob-Gyn Internal Medicine Otolaryngology Pediatrics Plastic Surgery Radiology Community Medicine Ophthalmology PM R Emergency Medicine Neurosurgery Orthopedic Surgery Psychiatry Urology Program Choices First Second ACGME-I Accredited Programs 9. Mandatory Enrollment Exams to HMC Residency Programs Exams 3-Digit Score Date No* of Attempts USMLE Step 1 USMLE Step 2 CK Clinical Knowledge IFOM - CSE a* Have you applied for the matching of HMC residency program before If Yes Date/s Program/s b. How did you learn about the Residency Program at HMC Internet/Social Media Newspaper Advertisement Friend Staff at HMC c* Did you apply for the Residency Program from outside Qatar If Yes pls. specify the country 3 of 5 d. Is your spouse working at HMC Yes f* Are you applying under the Sponsorship Program Yes 10. English Language Required Competency Exams Score IELTS TOEFL IBT / CBT / PBT If not available yet attached registration copy 11. Please indicate if you have done any the following a* Have you previously had a Clinical Attachment at HMC Yes b. Have you had any publications published or taken part in any scholarly activities previously If Yes please list the recent c* Have you attended any courses/workshops previously Yes 12.

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