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Get Hpcsa Form 10a

D return the ORIGINAL FORM duly completed to: The Registrar, Medical and Dental Professions Board, PO Box 205, Pretoria 0001 553 Vermeulen Street, Arcadia, Pretoria 0083 NAME OF INTERN: REG. No.: IN NAME OF ACCREDITED FACILITY: I, the undersigned, CEO/Chief Medical Superintendent of the above facility, hereby certify that the said intern completed internship training in the specified departments/domains of this facility for the periods specified, that he/she fulfilled the prescribed requiremen.

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