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Claim Form B - Induction and Refresher Placement Form: Week 1 Week 2 Week 3 Week 4

This form is used to record the hours worked by an induction and refresher (I&R) doctor during a placement at a general practice (GP). The form collects information about the I&R doctor such as their name and address, as well as details of the GP practice including the name, supervisor, and dates. The main purpose is to record the number of hours worked each week over a four week period to certify the placement and allow for reimbursement. Both the I&R doctor and supervisor must sign off that the recorded hours are accurate.

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Ivo_Nicht
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117 views2 pages

Claim Form B - Induction and Refresher Placement Form: Week 1 Week 2 Week 3 Week 4

This form is used to record the hours worked by an induction and refresher (I&R) doctor during a placement at a general practice (GP). The form collects information about the I&R doctor such as their name and address, as well as details of the GP practice including the name, supervisor, and dates. The main purpose is to record the number of hours worked each week over a four week period to certify the placement and allow for reimbursement. Both the I&R doctor and supervisor must sign off that the recorded hours are accurate.

Uploaded by

Ivo_Nicht
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Claim Form B - Induction and Refresher Placement Form

This form is to be completed by the I&R doctor and verified by the practice to
certify hours worked.
I&R Doctor
Name:

GP Practice
Name:

Address:

Supervisor/Trai
ner:

DATE(S)

Please ensure that the hours of work are recorded accurately below:
Week 1

Week 2

Week 3

Monday
Tuesday
Wednesday
Thursday
Friday
We certify that the totals hours worked are correct

Supervisor/Training Manager Signature:


Date:

Claim Form B
Created on: 28/9/2015 10.18
Created by: V Johnson & K Patel

Week 4

I&R Doctor Signature:


Date:

Claim Form B
Created on: 28/9/2015 10.18
Created by: V Johnson & K Patel

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