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    32 views1 page

    Affiliation Blank

    Uploaded by

    api-3739910

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    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
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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. ______________________________ 8. ______________________________
    2. ______________________________ 9. ______________________________
    3. ______________________________ 10. ______________________________
    4. ______________________________ 11. ______________________________
    5. ______________________________ 12. ______________________________
    6. ______________________________ 13. ______________________________
    7. ______________________________ 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. ______________________________ 8. ______________________________
    2. ______________________________ 9. ______________________________
    3. ______________________________ 10. ______________________________
    4. ______________________________ 11. ______________________________
    5. ______________________________ 12. ______________________________
    6. ______________________________ 13. ______________________________
    7. ______________________________ 14. ______________________________

    Prepared by: Recommended by: Approved by:

    ______________________ _______________________ ______________________


    Clinical Instructor Clinical Coordinator Chief Nurse

    Issue: 05April 2006 Revision Code: 003

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