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CU-QMS-NURSING-0025
CAPITOL UNIVERSITY COLLEGE OF NURSING Cagayan de Oro City AFFILIATION FORM Hospital: ________________________ Department: ____________ Date: __________________ Clinical Hours: ___________________ Class: __________________ Days: _________________ NAME OF STUDENTS: 1. 2. 3. 4. 5. 6. 7.
______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________
8. ______________________________ 9. ______________________________ 10. ______________________________ 11. ______________________________ 12. ______________________________ 13. ______________________________ 14. ______________________________
Prepared by:
Recommended by:
Approved by:
______________________ Clinical Instructor
_______________________ Clinical Coordinator
______________________ Chief Nurse
Issue: 05April 2006
Revision Code: 003
CU-QMS-NURSING-0025
CAPITOL UNIVERSITY COLLEGE OF NURSING Cagayan de Oro City AFFILIATION FORM Hospital: ________________________ Department: ____________ Date: __________________ Clinical Hours: ___________________ Class: __________________ Days: _________________ NAME OF STUDENTS: 1. ______________________________ 2. ______________________________ 3. ______________________________ 4. ______________________________ 5. ______________________________ 6. ______________________________ 7. ______________________________
8. ______________________________ 9. ______________________________ 10. ______________________________ 11. ______________________________ 12. ______________________________ 13. ______________________________ 14. ______________________________
Prepared by:
Recommended by:
Approved by:
______________________ Clinical Instructor
_______________________ Clinical Coordinator
______________________ Chief Nurse
Issue: 05April 2006
Revision Code: 003
CAPITOL UNIVERSITY COLLEGE OF NURSING Cagayan de Oro City AFFILIATION FORM Hospital: ________________________ Department: ____________ Date: __________________ Clinical Hours: ___________________ Class: __________________ Days: _________________ NAME OF STUDENTS: 1. 2. 3. 4. 5. 6. 7.
______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________
8. ______________________________ 9. ______________________________ 10. ______________________________ 11. ______________________________ 12. ______________________________ 13. ______________________________ 14. ______________________________
Prepared by:
Recommended by:
Approved by:
______________________ Clinical Instructor
_______________________ Clinical Coordinator
______________________ Chief Nurse
Issue: 05April 2006
Revision Code: 003
CU-QMS-NURSING-0025
CAPITOL UNIVERSITY COLLEGE OF NURSING Cagayan de Oro City AFFILIATION FORM Hospital: ________________________ Department: ____________ Date: __________________ Clinical Hours: ___________________ Class: __________________ Days: _________________ NAME OF STUDENTS: 1. ______________________________ 2. ______________________________ 3. ______________________________ 4. ______________________________ 5. ______________________________ 6. ______________________________ 7. ______________________________
8. ______________________________ 9. ______________________________ 10. ______________________________ 11. ______________________________ 12. ______________________________ 13. ______________________________ 14. ______________________________
Prepared by:
Recommended by:
Approved by:
______________________ Clinical Instructor
_______________________ Clinical Coordinator
______________________ Chief Nurse
Issue: 05April 2006
Revision Code: 003
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