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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

1. ______________________________________________ ________________________________________
2. ______________________________________________ ________________________________________
3. ______________________________________________ ________________________________________
4. ______________________________________________ ________________________________________
5. ______________________________________________ ________________________________________
6. ______________________________________________ ________________________________________
7. ______________________________________________ ________________________________________
8. ______________________________________________ ________________________________________
9. ______________________________________________ ________________________________________
10. ______________________________________________ ________________________________________
11. ______________________________________________ ________________________________________
12. ______________________________________________ ________________________________________
13. ______________________________________________ ________________________________________
14. ______________________________________________ ________________________________________

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.