7/28/2019 M29_Giay Xac Nhan Qua Trinh Thuc Hanh

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M u 29(Ban hnh km theo Quyt nh s 617/Q-UBND-HC

ngy 28 thng 6 nm 2013 ca Ch tch UBND tnh ng Thp)

1. Tn c s khm bnh, cha bnh.2. a danh3. i din c s khm bnh, cha bnh.4. Ghi r a ch theo ni ng k thng tr hoc tm tr5. Ghi theo n ca ngi ng k thc hnh.6. Ging nh mc 27. Ghi c th thi gian thc hnh t ngy.... thng...nm.... n ngy.... thng....nm...8. Nhn xt c th v kh nng thc hin cc k thutchuyn mn theo chuyn khoa ng k thc hnh

..1..................................

CNG HO X HI CH NGHA VIT NAMc lp T do Hnh phc

S: /GXNTH-. ...2, ngy thng nm 20

GIY XC NHN QU TRNH THC HNH

.......................3 xc nhn:

ng/b: ...........................................................................................................

Ngy, thng, nm sinh: ...................................................................................

Ch hin nay:4

............................................................................................Giy chng minh nhn dn/H chiu s:...................Ngy cp:.......... Ni cp:.............................

Vn bng chuyn mn: 5.......................... Nm tt nghip: .............................

thc hnh ti6................................................. . v t kt qu nh sau:

1. Thi gian thc hnh: 7.

2. Nng lc chuyn mn: 8..

Trong thi gian cng tc khng c vi phm o c ngh nghip.

Ti hon ton chu trch nhim v xc nhn ny./.

TH TRNG N V(K tn v ng du)