Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
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:
:
______________________________________________________________________
______________________________________________________________________
Permanent Address
:
______________________________________________________________________
Any Teaching Experience (if yes, details)
:
______________________________________________________________________
Area of Specialization & number of the therapies conducted : _____________________________________________________________________
(Details may be furnished in a separate sheet)
Number of patients in OPD per day
:
______________________________________________________________________
Whether maintaining any IPD, if yes. number of beds :
______________________________________________________________________
Other units of the hospital
i)
Medicine manufacturing section :
______________________________________________________________________
ii)
Panchakarma :
______________________________________________________________________
iii)
Ksharasutra
:
______________________________________________________________________
iv)
Any other :
_______________________________________________________________________
:
______________________________________________________________________
Clinic/hospital
(Details of facilities & infrastructure available)
Whether owned or employed
:
______________________________________________________________________
Publications
______________________________________________________________________
Fluency in Languages
i)
Readingii)
Writing iii)
Speaking 19. Whether practicing Ayurveda/Integrated
20. Your activities now a days
21. Whether working in any college/hospital on
regular/part-time basis.
:
:
:
:
:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
__________________________________________ ____________________________
__________________________________ ____________________________________
Enclosures:
Photocopies of certificates of Ayurvedic qualifications and medical registration.
DECLARATION :
I do hereby declare that the particulars furnished by me above are correct to the best of my knowledge and belief.
Date:
Signature of applicant
P.T.O.
Name of Institution
2.
3.
Registration No.
4.
Date of inauguration
5.
6.
7.
8.
9.
DECLARATION
I do hereby declare that the particulars furnished by me above are correct to the best of my knowledge and belief.
Date:
Signature of head of Deptt.
and office seal.