PANPACIFIC UNIVERSITY PANPACIFIC UNIVERSITY

Urdaneta City, Pangasinan Urdaneta City, Pangasinan

DEPARTMENT OF PHARMACY DEPARTMENT OF PHARMACY

Pharmacy Internship Pharmacy Internship

Name of Intern: Ching D. Chen Name of Intern: Ching D. Chen
Name of Establishment: ROSARIO DISTRICT Name of Establishment: ROSARIO DISTRICT
HOSPITAL HOSPITAL
Community ______ Hospital _____ Community ______ Hospital _____
Manufacturing _____ Major _______ Manufacturing _____ Major _______

For the Month of: May Year: 2019 For the Month of: June Year: 2019
Date A.M. P.M. Number of: Date A.M. P.M. Number of:

Arrival Departure Arrival Departure HOURS MINUTES Arrival Departure Arrival Departure HOURS MINUTES
1 1

2 2

3 3 8:00 12:00 1:00 5:00 8

4 4 8:00 12:00 1:00 5:00 8

5 5

6 6

7 7 8:00 12:00 1:00 5:00 8

8 8

9 9

10 10 8:00 12:00 1:00 5:00 8

11 11 8:00 12:00 1:00 5:00 8

12 12

13 13 8:00 12:00 1:00 5:00 8

14 14 8:00 12:00 1:00 5:00 8

15 15

16 16

17 17 8:00 12:00 1:00 5:00 8

18 18 8:00 12:00 1:00 5:00 8

19 19 8:00 12:00 1:00 5:00 8

20 8:00 12:00 1:00 5:00 8 20 8:00 12:00 1:00 5:00 8

21 8:00 12:00 1:00 5:00 8 21 8:00 12:00 1:00 5:00 8

22 8:00 12:00 1:00 5:00 8 22

23 8:00 12:00 1:00 5:00 8 23

24 8:00 12:00 1:00 5:00 8 24 8:00 12:00 1:00 5:00 8

25 25 8:00 12:00 1:00 5:00 8

26 26 8:00 12:00 1:00 5:00 8

27 8:00 12:00 1:00 5:00 8 27 8:00 12:00 1:00 5:00 8

28 8:00 12:00 1:00 5:00 8 28 8:00 12:00 1:00 5:00 8

29 8:00 12:00 1:00 5:00 8 29

30 8:00 12:00 1:00 5:00 8 30

31 8:00 12:00 1:00 5:00 8 31

TOTAL: __80__HOURS TOTAL: __136__HOURS

Certified by: Certified by:

CHING D. CHEN CHING D. CHEN

FIDEL M. MABALOT, MD, MPA
Director/Manager of Firm
Noted by:
ALDRIN B. MIRANDA, RPh
Internship Coordinator’s
JENILYN Q. FARNACIO, RPh
OIC’S NAME AND SIGNATURE
Intern’s Signature FIDEL M. MABALOT, MD, MPA Intern's Signature
ROWENA R. SORIANO, RPh Director/Manager of Firm ROWENA R. SORIANO, RPh
Name & Signature of Pharmacist-in-Charge Name & Signature of Pharmacist-in-Charge
Noted by:
Prof. Tax No. (PTR): Government Employee ALDRIN B. MIRANDA, RPh Prof. Tax No. (PTR): Government Employee
Date Issued: 02/19/2016 Internship Coordinator's Date Issued: 02/19/2016
Reg. No. (License): 0043259 Reg. No. (License): 0043259
Date Issued. 03/13/2000 JENILYN Q. FARNACIO, RPh Date Issued. 03/13/2000
Date of Expiry: 02/15/2022 OIC’S NAME AND SIGNATURE Date of Expiry: 02/15/2022