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1. Rotation Information

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* 1. Please fill out the following information:

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* 2. In which community you did your rotation?

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* 3. In which clinic/hospital you did your rotation?

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* 4. Rotation Dates:

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Date

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* 5. University:

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* 6. Which rotation/s you had done during your rotation dates?

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* 7. Level of Training

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* 8. Year in Program

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* 9. Which community choice did you receive?

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* 10. Please identify your main reason(s) for participating in a ROMP-facilitated rotation:

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