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Preceptor Affidavit Change Form (Pharmacy)

Form Details

Owner: State, Professional Regulations - Board of Pharmacy


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Description: I hereby certify that I accept the responsibility of a preceptor for . I agree to provide him/her with the experience outlined in the Board's Practical Experience Program. If I terminate my preceptorship agreement with the applicant, I will notify the Board in writing. I also hereby certify that I am a registered pharmacist and have been practicing for at least two years.

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Last Updated: Thursday, 28-Feb-2013
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