enrollment form 2014-2015

8/11/2019 Enrollment Form 2014-2015

1/18

Charles University in Prague, Faculty of Medicine in Pilsen

ENROLLMENT FORM-2014/2015

General Medicine 6

th

yearSRN!ME

Fir"t na#e

Middle na#e"

$ate %& 'irth ($ )*a""+%rt, N%

T%.n/c%ntry Nati%nality

%& irth

Your address abroad:

Telephone:

Fax No : !ail:

"ddress in C#ech $epublic:

Telephone:

!ail:


2/18

General Medicine 6thyear

ENROLLE$ S'ETSMini## N% %& E &%r enr%ll#ent in the 6th year - 235

S'ETS No% of hours per &ee' (lectures)practicals*&inter se!ester No%of C

+% nternal Medicine +- &ee's 16

.% /bstetrics and 0ynecology 1 &ee's 10

2% Pediatrics . &ee's 10

1% 3ocial Medicine and Public 4ealth 2 &ee's

5% 3urgery 6 &ee's 16

Oer.r%ht "7ect" / (ndiidal "tdy +lan

Tuition fee pay!ent: 777777 (date*

S(GN!TRE

F/$ /FFC"8 U3:

9atu! #pisu:

Platba ; +* datu!


3/18



0eneral Medicine ; 5

th

year3U$N"M

First na!e

Middle na!es

9ate of =irth 9 (Passport* No%

To&n)country Nationality

of birth


Telephone:

Fax No : !ail:


Telephone:

!ail:


4/18

General Medicine 5thyearENROLLE$ S'ETS

Mini## N% %& E &%r enr%ll#ent in the 5th year - 228

S'ETS

No% of hours per &ee' (lectures)practicals*

No% of C+% "nesthesiology and $esuscitation 6 C, 4

.% Clinical =ioche!istry > C, 2

2% Clinical /ncology >C 1

1% ar, Nose and Throat 9iseases 6 C, 4

5% pide!iology > C, 2

>% nfectious 9iseases 6 C, 4

?% nternal Medicine >C 2

@% Medical 0enetics 2C 1

6% Neonatology 5 C 2

+-% /bstetrics and 0ynecology +. C 8++% /phthal!ology 6 C, 4

+.% /rtopedics and Trau!atology +. C, 5

+2% Pediatrics +- C 6

+1% Psychiatry +. C, 5

+5% Public 4ealth >C 1

+>% 3ocial Medicine and =iostatistics > C 1

+?% 3pecial Fields of nternal Med% >C 2

+@% 3urgery 2- C 2

3 A C 5



S(GN!TRE

F/$ /FFC"8 U3:

9atu! #pisu:

Platba ; +* datu!


5/18


6/18

General Medicine 4thyearENROLLE$ S'ETS

Mini## N% %& E &%r enr%ll#ent in the 4th year - 183

S'ETS


&inter)su!!er se!ester No%of%C+% 9er!atovenerology +)2 C, 4

.% Forensic Pathology > C, 9

2% nternal Medicine .)2 C .)2 C

1% Neurology +). C +). C, 3

5 Phar!acology 1). C, 3

>% Propedeutics of 3urgery .). C, 4

?% $adiology and Nuclear Med% +)+ C +)+ C, 4

@% 3ports Medicine +)+ C 1

6% 3to!atology +)+ C, 2+-% 3urgery .)2 C 9

++% 3P nternal Medicine . &ee's 9

+.% 3P 3urgery . &ee's 9

+2% Urology +)- C +)+C, 9

3: 4

Oer.r%ht "7ect" / (ndiidal Stdy *lan


S(GN!TRE

F/$ /FFC"8 U3:

9atu! #pisu:

Platba ; +* datu!


7/18



0eneral Medicine ; 2rdyear

3U$N"M

First na!e

Middle na!es



of birth


Telephone:

Fax No : !ail:


Telephone: !ail:


8/18

General Medicine 9rdyear

ENROLLE$ S'ETSMini## N% %& E &%r enr%ll#ent in the 9rd year 3

S'ETS


&inter)su!!er se!ester No% of CB

+% !!unology .)- C, 9

.% nternal Medicine .)2 C 9

2% Medical Psychology +)+ C +). C, 5

1% Microbiology .)- C, 5

5% Pathological Physiology .)2 C 2)1 C, 19

>% Pathology 5)2 C 1)2 C, 18

?% Phar!acology +). C 9

@% Prop% of nternal Medicine 2)1 C, 63: 5



S(GN!TRE

F/$ /FFC"8 U3:

9atu! #pisu:

Platba ; +* datu!


9/18


ENROLLMENT FORM-2014/20150eneral Medicine ; .ndyear

3U$N"M

First na!e

Middle na!es



of birth

Your C#ech 3" expires on %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%


Telephone: Fax No : !ail:


Telephone: !ail:


10/18

General Medicine 2ndyear

ENROLLE$ S'ETSMini## N% %& E &%r enr%ll#ent in the 2nd year 40

S'ETSNo% of hours per &ee' (lectures)practicals*

&inter) su!!er se!ester

No% of C

+% =ioche!istry .)1 C 1)1 C, 14

.% C#ech for Foreigners -)1 C -)1 C, 9

2% 4istology and !bryology .)2 C, 6

1% Physiology 1)1 C >)5 C, 22

5% Topographical "nato!y .)1 C, 6

>% 3P A Nursing 2 &ee's C 9

?% Microbiology -). C 23: 4



30N"TU$ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

F/$ /FFC"8 U3:

9atu! #pisu:

Platba ; +* datu!


11/18



9entistry ; .

nd

year3U$N"M

First na!e

Middle na!es



of birth


Telephone:

Fax No : !ail:


Telephone:

!ail:


12/18

$enti"try Medicine 2ndyear

ENROLLE$ S'ETSMini## N% %& E &%r enr%ll#ent in the 2nd year - 42

S'ETS


&inter) su!!er se!ester No% of C

+% =ioche!istry .)+,5 C, 6

.% =iology and 0enetics .). C, 5

2% Clinical 9entistry -). C 2

1% C#ech for Foreigners -)1 C -)1 C, 1

5% 4istology and !bryology +). C, 9

>% Pathology and /ral Pathology .). C 9

?% Physiology 2)2 C 2)2 C, 16

@% Preclinical 9entistry .)1 C .)+ C, 126% Preventive 9entistry .)- C 0

+-% Prothetic Technology +)5 C, 2

++% Psychology and Co!!% &ith patient -)+ C 1

+.% 3u!!er Practice + &ee' 1

+2% Top% "nato!y of the 4ead and Nec' +). C, 9

ES: 5



S(GN!TRE

F/$ /FFC"8 U3:

9atu! #pisu:

Platba ; +* datu!


13/18


14/18

$enti"try 9rdyear

ENROLLE$ S'ETSMini## N% %& E &%r enr%ll#ent in the 9rd year - 104

S'ETS


&inter)su!!er se!ester No% of C

+% Clinical 9entistry -)> C -)> C 10

.% Conservative 9entistry and ndodontics +)- +)- -

2% 9ental $adiology +)+ C, 6

5% !!unology -)+ C, 2

>% nternal Medicine 2). C 4

?% Microbiology .). C, 9

@% /ral and Maxillofacial 3urgery +)- +)- -

6% /ral =iology +)- C, 2+-% Pathological Physiology .). C, 8

++% Pathology and /ral Pathology .).C, 10

+.% Phar!acology .)+ C .)+ C, 6

+2% Prosthodontics +)- +)- -

+1% Psychiatry +)+C, 9

+5% 3u!!er Practice . &ee's 2

ES: 5



S(GN!TRE

F/$ /FFC"8 U3:

9atu! #pisu:

Platba ; +* datu!


15/18



9entistry ; 1thyear

3U$N"M

First na!e

Middle na!es



of birth


Telephone:

Fax No : !ail:


Telephone:

!ail:


16/18

$enti"try 4thyear


S'ETS


&inter)su!!er se!ester No% of C+% 3urgery .). C .). C 4

.% nternal Medicine .). C .). C, 9

2% nfectious 9iseases and pide!iology +)+ C, 2

1% Neurology +)+ C, 9

5% /phtal!ology +)+ C, 2

>% Clinical 9entistry -)+. C -)+@ C 3

?% Prosthodontics +)- +)- C, 6

@% /ral and Maxillofacial 3urgery +)- +)- C, 8

6% Conservative 9% and ndodontics +)- C, +-% /rthodontics +)- +)- 0

++% Pediatric 9entistry .)- 0

+.% Pediatrics +)+ C, 4

+2% /bstetrics and 0ynecology +)+ C, 2

+1% Paronontology +)- C, 9

+5% 3to!atological Practice 1 &ee's 2

+>% 9er!atovenereology +)2 C, 9

ES: 5

Oer.r%ht "7ect" / (ndiidal Stdy +lan


S(GN!TRE

F/$ /FFC"8 U3:

9atu! #pisu:

Platba ; +* datu!


17/18



9entistry ; 5

th

year3U$N"M

First na!e

Middle na!es



of birth


Telephone:

Fax No : !ail:


Telephone:

!ail:


18/18

$enti"try 5thyear


S'ETS


&inter)su!!er se!ester No% of C+% "nesthesiology +)+ C, 4

.% 3urgery +). C, 6

2% Manage!ent in 9entistry -)+ C 1

1% ar, Nose and Throat 9iseases .)+ C, 4

5% Public 4ealth Medicine +)+ 2

>% /ral 4ealth Medicine +)+ C 2

?% Clinical 9entistry -)+@ C .)> C 10

@% Parodontology -). 3 5

6% Prosthodontics +). 3 5+-% Pediatric 9entistry -)+. C -). 3 5

++% /ral and Maxillofacial 3urgery 2)- -). 3 5

+.% /rthodontics -). 3 5

+2% Conser% 9entistry and ndodontics -). 3 5

+1% Forensic 9entistry -,5)-,5 C, 1



S(GN!TRE

F/$ /FFC"8 U3:

9atu! #pisu:

Platba ; +* datu!

enrollment form 2014-2015

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