UNIVERSITY OF HEALTH SCIENCES LAHORE (for office use only)
KHAYABAN-E-JAMIA PUNJAB LAHORE
Ph: No. (Off) 042-99231304-9 Fax No. 042-99230870 Form No:-_______
APPLICATION FORM FOR PUNJAB RESIDENCY PROGRAM
(LEVEL – IV) TRAINING
Please affix 4
Photographs
PMDC Number:- ------------------------------ Dated:---------------------- attested from
backside. (4x4)
CNIC Number:-___________________________
Applicant’s Personal Information
P
Full Name (First, Middle, Last) Please fill all information in CAPITAL Letter
1.
Father’s Name (First, Middle, Last)
2.
Date of Birth (DD/MM/YYYY) Age Gender
3. 4. 5.
Address
6.
Contact no. E-mail Address Domicile
7. 8. 9.
House Job Degree
10. Public Private Foreign
Educational Information
(MBBS/BDS)
Year Name of Institution Obtained Total No. of
Marks Marks Attempts
1
5
FCPS / MD / MS / Equivalent Qualification
Candidate successful in first attempts in final examination
Candidate successful in second attempt in final examination
Cand idate successfu l in third or subsequ ent attempt in final Examination
Work Experience (experience obtained after completion of Post-graduation)
Period Duration
Institute
Designation
From To Year Month
Research Papers / Publications with Impact Factor
(Attach a complete list with proper citations)
Publication Title Authorship Name of Journal Impact
(Number) Factor
Oral paper presentation
Sr # International conference held in Pakistan International conference held abroad
4
Provide the list of level IV Qualification against referred institutions in order of preferences in the Table
given below (for your convenience list of PM&DC Approved Level IV Qualification are provided at the
end of the form)
Order of Signature of
Preference Level IV Qualification FCPS/MS/MD Institute
Applicant
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Order of Signature of
Level IV Qualification FCPS/MS/MD Institute
Preference Applicant
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Hous
eJobCe
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cat
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List of Approved Level 4 Qualification
S.NO. Subspecialty name Eligibility Criteria
CPSP Programs
1 Cardiothoracic Anesthesiology FCPS/MD Anesthesiology
2 Child and Adolescent Psychiatry FCPS/MD Psychiatry
3 Clinical cardiac electrophysiology FCPS/MD Cardiology
4 Community and Preventive Pediatrics FCPS/MD Pediatrics
5 Critical Care Medicine FCPS/MS Anesthesiology
6 Developmental and Behavioral
Pediatrics FCPS/MD Pediatrics
7 Endocrinology FCPS/MD Medicine
8 Gynaecological oncology FCPS/MS Gynecology and Obstetrics
9 Infectious Diseases FCPS/MD Medicine
10 Interventional Cardiology FCPS/MD Cardiology
11 Materno Foetal Medicine FCPS/MS Gynaecology and Obstetrics
12 Neonatal Pediatrics FCPS/MD Pediatrics
13 Orbit and oculoplastics FCPS/MS Ophthalmology
14 Paediatric Cardiology FCPS/MD Pediatrics
15 Pediatric Gastroenterology FCPS/MD Pediatrics
16 Pediatric Hematology/Oncology FCPS/MD Pediatrics
17 Pediatric Infectious Diseases FCPS/MD Pediatrics
18 Paediatric Nephrology FCPS/MD Pediatrics
19 Paediatric Neurology FCPS/MD Pediatrics
20 Pediatric Ophthalmology FCPS/MS Ophthalmology
21 Pain Medicine FCPS/MS Anesthesiology
22 Reproductive endocrinology and
infertility FCPS/MS Gynecology and Obstetrics
23 Rheumatology FCPS/MD Medicine
24 Surgical Oncology FCPS/MS Surgery
25 Urogynaecology FCPS/MS Gynecology and Obstetrics
26 Vascular surgery FCPS/MS Surgery
27 Vitero Retinal Ophthalmology FCPS/MS Ophthalmology
University Programs
Paediatric Orthopaedic Surgery MS/FCPS Orthopedics
Paediatric Neurosurgery MS/FCPS Neurosurgery
Paediatric Ophthalmology MS/FCPS Ophthalmology
Vitero Retinal Ophthalmology MS/FCPS Ophthalmology
Cornea MS/FCPS Ophthalmology
