INTERN JOINING REPORT

1. Name of the Intern: ________________________

2. Enrolment No ________________________
Affix Passport
3. Residential Address: ________________________ size photograph
________________________
4. Mobile no. ________________________
5. Email id ________________________
6. DCPTOT Registration NO. _______________________
7. Date of joining _____/__________/________
8. Name & address of Place of internship
__________________________________________________________________________
9. Bed strength of the hospital _______________________
10. Name of the HOD Physiotherapy of the hospital _______________________________
Mobile no. ____________________Email id__________________________________

Schedule of Posting
Sl. No. Specialty /Departments of posting Date (s) of posting
From Till
1. Orthopedics (including ICSU)
2. Neurology (including ICU)
3. Medicine (including ICMU)
4. Surgery (including ICSU)
5. Paediatrics/Geriatrics
6. Community Physiotherapy /CBR & Rural
Exposure

Signature of Intern

The above mentioned Intern has joined as per the details mentioned above

Seal of the hospital

Signature

Name …………………………

Designation ………..……………..

Note: It is mandatory to submit duly completed joining report to the Officiating Incharge, Banarsidas Chandiwala Institute Of
Physiotherapy within 7 days of the joining date ,failing which the internship shall stand cancelled