HOJA DE OBSERVACIONES SOBRE LA EVALUACIÓN MENSUAL DEL RESIDENTE

Nombres y apellidos: ________________________________________________________________

Cédula de Identidad No: _________________________________

Especialidad: ___________________ Periodo de residencia: _____ Curso: ______ Mes: _______

Lugar donde labora: _________________________________________________________________

Observaciones:
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FIRMA DEL RESIDENTE FIRMA DEL TUTOR PRINCIPAL FIRMA DEL TUTOR DEL TEG

FECHA DE CIERRE: __________