Mu s 2/GPP

CNG HO X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
.., ngy

thng

nm

N NG K KIM TRA THC HNH TT NH THUC

(ti kim tra)
Knh gi: S Y t .
Tn c s.................................................................................................................
Trc thuc (nu trc thuc cng ty, bnh vin)...................................................
a ch:....................................................................................................................
in thoi................................................................................................................
Ngi ph trch chuyn mn:.................................................................................
Chng ch hnh ngh dc s:................................................................................
do S Y t . cp ngy:......................................................................
................................................................................................................................
c cp Giy chng nhn Thc hnh tt nh thuc s:.Ngy cp:....
T ngy c cp n nay, c s c nhng thay i sau:
1.
2. ....
3. (ghi r vn bn ng ca S Y t v nhng thay i/b sung phi xin php).

C s chng ti ngh S Y t . kim tra cng nhn c s chng

ti t tiu chun nguyn tc Thc hnh tt nh thuc.
NGI PH TRCH/CH C S