DEPARTMENT OF NEUROSURGERY

Bangabandhu Sheikh Mujib Medical University

RESIDENT'S PROFILE Recent Passport
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Personal Information:

Resident's Name (in block letters)

Father's Name
Mother's Name
Permanent Address
Present Address
Nationality
Date of Birth
National ID No.
Passport No. (If Present)
Marital Status
Spouse’s Name with Contact No.
(If Married)
Email ID
Contact Number (Phone)
Contact Number (Mobile)
Blood Group

Academic Qualification:

Level School/College Board / Passing GPA /

University Year Division
SSC/Equivalent
HSC/Equivalent

MBBS

Residency Information (Current):

BMDC Registration No.

Session
E-registration No.
Phase
Year
Block

Signature:

Full Name:

Phase A
Date of Joining:

Year 1 Dr. Haradhan Deb Nath

No Name of Block Time of Duration Placed Unit Chief

placement Unit

1 Neurosurgery 3 months

2 Psychiatry 15 days
 3 Radiology 15 days

4 ENT 1 month

5 Ophthalmology 1 month

6 ICU and Anaesthesiology 1 month

7 Orthopedic surgery 1 month

8 Neuro-emergency (DMC) 1 month

9 Neurology 3 months

Year 2 Dr. Ayub Ansari

10 General surgery 3 months

11 General surgery 3 months

12 Neurosurgery 3 months

Signature:

Full Name:

Phase B
Date of Joining:

Year 1 Dr. Mohammad Hossain

No Name of Block Time of Duration Placed Unit Chief
placement Unit

1 3 months

2 3 months
 3 3 months

4 3 months

Year 2 Dr. Dhiman Chowdhury

5 3 months

6 3 months

7 3 months

8 3 months

Year 3 Dr. Moududul Haque

9 3 months

10 3 months

11 3 months

12 3 months

Signature:

Full Name: