Medical Internship Certificate Template - Free Download
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Medical Internship Certificate Template
Medical Internship Certificate Template
:09-2902900, 2901435, 2901349, e-mail:info@mdcn.org, www.mdcn.org
CABLES & TELEGRAMS MEDCOUNCIL ABUJA
A Parastatal of the Federal Ministry of Health. Established by Cap M8, Laws of the Federation 2004.
HEAD OFFICE:
F Close, 1
s
t
Avenue, Block II, Gwarinpa F.H.A. Estate. P.M.B 458, Garki,
FORM F
(Doctor’s Copy)
PASSPORT
The Completed form must be returned directly to the Registrar of Council by the Hospital Administration
IMMEDIATELY after the intern is signed.
MEDICAL AND DENTAL COUNCIL OF NIGERIA
HOUSE OFFICERS’ (INTERNSHIP) PERFORMANCE REPORT
HOUSE OFFICERS’ (INTERNSHIP) PERFORMANCE REPORTHOUSE OFFICERS’ (INTERNSHIP) PERFORMANCE REPORT
HOUSE OFFICERS’ (INTERNSHIP) PERFORMANCE REPORT
Note Well: All entries in this form, except signatures, must be type-written, or written in capital letters.
(TO BE COMPLETED BY THE HOUSE OFFICER)
A HOUSE OFFICER’S PARTICULARS
(a) Full Names:
Surname First Name Middle Name
(b) Permanent Home Address:
(c) E-mail/Phone Number:
(d) Medical School/University Attended:
(e) Period of Attendance:
(f) Qualification Obtained (with date):
(g) Medical and Dental Council Registration Number:
(h) Date of Provisional Registration:
(i) Name of Training Hospital:
(TO BE COMPLETED BY SUPERVISING CONSULTANT)
B.
(a) Department of Posting:
(b) Period of House Officer’s Posting in the Department
From:
Day Month Year
To:
Day Month Year
C. PERFORMANCE EVALUATION BY THE SUPERVISING CONSULTANT
(a) Rating Scale
A = Excellent (80% and above)
B = Very Good (70 – 79%)
C = Good (60 – 69%)
D = Average (50 – 59%)
E = Below Average (40 – 49%)
F = Unsatisfactory (Below 40%)
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source: mdcn.gov.ng
Medical Internship Certificate Template
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