LYCEUM-NORTHWESTERN UNIVERSITY

DR. FRANCISCO Q. DUQUE MEDICAL FOUNDATION

COLLEGE OF MEDICINE
Dagupan City

WARD WORK
Attendance Sheet
( ) Second Year ( ) Third Year

DEPARTMENT OF:
( ) Medicine ( ) Surgery ( )Pediatrics ( ) OB-Gyn

Name of Hospital: ____________________________________________________________________________

Date of Duty: _________________________________Time: _________________________________________
Consultant/Preceptor Assigned: ___________________________________________________________

GROUP ASSIGNED: _____________________________

Students’ Name and Signature

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Submitted by: Noted by:

____________________________ ____________________________________
Consultant/ Preceptor Department Chairman

Note: This attendance sheet must be submitted to the Office of the Dean by the Consultant/Preceptor
for Billing purposes.