P.D.U.

Medical College And

Saurashtra University Rajkot

LOGBOOK
(ELECTIVES POSTING)

Department Of Plastic
Surgery

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 CERTIFICATE
This is certify ____________________ Roll
No. ________ Batch ______worked in
department of plastic surgery during
elective posting of plastic surgery from
15/02/2023
5/2/2024 to 28/02/2023.
18/2/2024

Signature of HOD

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 Department of Plastic Surgery
PERSONAL BIO-DATA

FULL NAME OF STUDENT: __________________________________________

DATE OF JOINING : __________________________________________

DATE OF BIRTH : __________________________________________

PERMANENT ADDRESS : __________________________________________

__________________________________________

___________________________________________

MOBILE NO: _______________________

EMAIL : _______________________

LOCAL (GUARDIAN) ADDRESS: _____________________________________

____________________________________

____________________________________

CAMPUS ADDRESS :. _____________________________________________

HOSTEL & ROOM NO: ______________________________________________

BLOOD GROUP : ______________________________________________

ELECTIVE TOPIC : _______________________________________________

_______________________________________________

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 OPD
DATE Sr.No Procedure Work Done
Surgery

4 / 11
 OPD
DATE Sr.No Procedure Work Done
Surgery

5 / 11
 OPD
DATE Sr.No Procedure Work Done
Surgery

6 / 11
 OPD
DATE Sr.No Procedure Work Done
Surgery

7 / 11
 OPD
DATE Sr.No Procedure Work Done
Surgery

8 / 11
 OPD
DATE Sr.No Procedure Work Done
Surgery

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 OPD
DATE Sr.No Procedure Work Done
Surgery

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 OPD
DATE Sr.No Procedure Work Done
Surgery

Total No Of Days:14. Present Days______. Absent Days_______

Name Of Student Name Of HOD

Date Date

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