Masaryk University, Faculty of Medicine
Kamenice 753/5, 625 00 Brno, Czech Republic
T: +420 549 49 5720, E: info@med.muni.cz, www.med.muni.cz
Bank account: KB Brno, Ref. No.: 85636621/0100, ID: 00216224, Tax ID: CZ00216224
5th year of General Medicine
RECORD of summer holiday practice
and EVALUATION of the student
academic year ……………………….
Student
Name + UČO
Hospital and
Dept. name
A. Subject B. Evaluation of the student
Obstetrics and Gynecology
(2 weeks – 60 hours)
From: ........................................
To: ............................................
...........................................
stamp and signature
Remarks:
Section A. and B. must be filled in by a hospital’s official who is responsible for the practical training, evaluation of
the student’s character, skill, diligence, attendance, etc.
Record on practical training serves as a document completion of the compulsory practice and for giving credit in
the student’s record unit.