Medical Internship Information Form PDF
Document Details
Uploaded by SelectiveCadmium
King Saud bin Abdulaziz University for Health Sciences
2023
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Summary
This form is for a medical internship, specifically, a Rotating Medical Intern Information Form from King Saud bin Abdulaziz University for Health Sciences. The form asks for personal information, details about the medical internship. The intern information includes name, contact details, medical school, and emergency contact information.
Full Transcript
King Saud bin Abdulaziz University for Health Sciences College of Medicine Clinical Affairs MEDICAL INTERNSHIP UNIT جامعة الملك سعود بن عبدالعزيز للعلوم الصحية الشئون السريرية-كلية الطب 8011111 ext: 11587 /12154 11012 1418 Email: [email protected] ROTATING MEDICAL INTERN INFORMATION FO...
King Saud bin Abdulaziz University for Health Sciences College of Medicine Clinical Affairs MEDICAL INTERNSHIP UNIT جامعة الملك سعود بن عبدالعزيز للعلوم الصحية الشئون السريرية-كلية الطب 8011111 ext: 11587 /12154 11012 1418 Email: [email protected] ROTATING MEDICAL INTERN INFORMATION FORM ROTATION: SUR MED OBG PED OTHERS (please specify): ________________ ER FM ELECTIVE MANDATORY 1 month. TRAINING PERIOD: _________________________________________________________________________________ Abanumay. NAME: _______________________ Last Waleed. ______________________ First GENDER: FEMALE MALE Thamer. _______________________ Father Abdulaziz. ___________________ Grandfather Saudi 1108247816 NATIONALITY: _______________________________NATIONAL ID No._____________________________________ Abi bakr Al siddiq, Al-nada street 24 HOME /MAILING ADDRESS:_________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ E-MAIL ADDRESS: [email protected] _________________________________ 0567743411 MOBILE NO: ________________________________ MEDICAL SCHOOL: Imam Mohammed ibn saud Islamic university. INSTITUTION: ________________________________ ADDRESS:_________________________________________ 2023. GRADUATION DATE: __________________________ 3.44 GPA :_____________________________________________ FAX NUMBER (required for evaluation): _______________________________________________________________ CONTACT PERSON AND NUMBER (Department secretary): [email protected] ____________________________________________________________________________________________________ PERSON TO CONTACT IN CASE OF EMERGENCY: abanumay NAME: Thamer ____________________________________________________________________________________________ ADDRESS: _________________________________________________________________________________________ Abi bakr Al siddiq Al nada street 24 PHONE NUMBER: __________________________________________________________________________________ 0555086375 an ___________________________________ Intern Signature NOTE: Please come back or call Medical Internship Unit office once you have a badge & pager number and on the last day of your rotation /internship for completion of clearance. Ext: 11587 / 12154
