Get Health And Activity Record Form Filled Sample

HEALTH PROFESSIONS COUNCIL OF SOUTH AFRICA INDIVIDUAL ACTIVITY RECORD Form CPD 1 IAR Please complete and return to The CPD Officer HPCSA P O Box 205 PRETORIA 0001 or submit the above with the supporting documentation electronically to cpd hpcsa.co. za or fax to 012 3285120. This record is the only data collection required for individual practitioners. It must be duly completed and accurately reflect your CPD activities. Please attach certificates. Professional Board Registration No* with HPCSA Surname First Names ID Number Date of the Audit AUGUST 2009 Please indicate the category in which you are currently working Public Service Training institution Private Practice Research Education Other. Points accrued Please attach certificates Date Name of Provider Description of Activity/Accreditation From To Lev 1 Lev 2 Lev 3 Ethics Human Rights or Medical Law Total TOTAL I the undersigned certify that the information contained in this Individual Activity Record and the attached certificates are correct in all respects. za or fax to 012 3285120. This record is the only data collection required for individual practitioners. It must be duly completed and accurately reflect your CPD activities. Please attach certificates. Professional Board Registration No* with HPCSA Surname First Names ID Number Date of the Audit AUGUST 2009 Please indicate the category in which you are currently working Public Service Training institution Private Practice Research Education Other. It must be duly completed and accurately reflect your CPD activities. Please attach certificates. Professional Board Registration No* with HPCSA Surname First Names ID Number Date of the Audit AUGUST 2009 Please indicate the category in which you are currently working Public Service Training institution Private Practice Research Education Other. Points accrued Please attach certificates Date Name of Provider Description of Activity/Accreditation From To Lev 1 Lev 2 Lev 3 Ethics Human Rights or Medical Law Total TOTAL I the undersigned certify that the information contained in this Individual Activity Record and the attached certificates are correct in all respects. za or fax to 012 3285120. This record is the only data collection required for individual practitioners. It must be duly completed and accurately reflect your CPD activities. Please attach certificates. Professional Board Registration No* with HPCSA Surname First Names ID Number Date of the Audit AUGUST 2009 Please indicate the category in which you are currently working Public Service Training institution Private Practice Research Education Other. Points accrued Please attach certificates Date Name of Provider Description of Activity/Accreditation From To Lev 1 Lev 2 Lev 3 Ethics Human Rights or Medical Law Total TOTAL I the undersigned certify that the information contained in this Individual Activity Record and the attached certificates are correct in all respects. .