CONFIRMATION AND EVALUATION OF THE PRACTICE
POTVRZENÍ O VYKONÁNÍ PRAXE A HODNOCENÍ STUDENTA
In case of any question or problem please contact FaF, MU:
PharmDr. L. Smejkalova, Ph.D., PharmDr. T. Ambrus, Ph.D.,
e-mail: ambrust@pharm.muni.cz, smejkaloval@pharm.muni.cz
INTRODUCTORY PHARMACY INTERNSHIP FAPL1
students of Pharmacy at Faculty of Pharmacy, Masaryk University
Úvodní lékárenská praxe (FARP1)
posluchačů Farmaceutické fakulty Masarykovy Univerzity
Hereby I confirm that the below mentioned student of the Faculty of Pharmacy
Masaryk University attended the Introductory pharmacy internship (2 weeks)
Tímto potvrzuji, že níže uvedený student FaF MU vykonal Úvodní lékárenskou praxi (2 týdny)
Academic year/Akademický rok: 2019/2020
Name of the student, ID number/Jméno a příjmení studenta, osobní číslo:
…………………………………………………………………………………………………................................................
Name and address of the pharmacy/Název a adresa lékárny:
…………………………………………………………………………………………………................................................
…………………………………………………………………………………………………................................................
Date of the training/Termín praxe: from/od…………………………to/do: ……………………………………
Name of the supervisor (at the training workplace)/Praxi vedl:
___________________________________________________________________________
Evaluation by the student´s supervisor/Hodnocení studenta vedoucím praxe:
…………………………………………………………………………………………………................................................
…………………………………………………………………………………………………................................................
…………………………………………………………………………………………………................................................
…………………………………………………………………………………………………................................................
Date/Datum:………….. ………………………………………………………….
Signature of the pharmacy manager
Official stamp
Personal data protection:
All personal data listed in the Paper of Acceptation are treated according to the General Data Protection Regulation (GDPR) (EU) 2016/679.
Pharmacists in question agree with the processing of their personal data necessary for the performance of the student’s professional
pharmacy experience. The appointed data will not be kept longer than necessary, with the time limit being five years after the completion
of the Master’s Degree Study.