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HMS Exclerk Application

This document contains application information for Ayesha Ehsan, a student at Services Institute of Medical Sciences in Pakistan, who is applying for an externship at Harvard Medical School in February 2019. It lists her requested clerkships in neurology, pediatrics, psychiatry, infectious disease and other specialties at various Harvard affiliated hospitals. It also provides her current medical school and contact details as well as citizenship and demographic information.

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Fatima M
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79 views2 pages

HMS Exclerk Application

This document contains application information for Ayesha Ehsan, a student at Services Institute of Medical Sciences in Pakistan, who is applying for an externship at Harvard Medical School in February 2019. It lists her requested clerkships in neurology, pediatrics, psychiatry, infectious disease and other specialties at various Harvard affiliated hospitals. It also provides her current medical school and contact details as well as citizenship and demographic information.

Uploaded by

Fatima M
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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HARVARD MEDICAL SCHOOL

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Exclerk Application Information


Last: Ehsan Date of Birth: 10/16/1994
First: Ayesha Gender: F
Middle: Emergency Contact: Amy Rassier
Email: [email protected] Emergency Phone: +14064809662

Clerkship Months / Dates Requested


Clerkship Date(s)
Feb 02/04/2019 - 03/03/2019

Clerkships Requested
Pref Course Title When Offered Location
1 NN501M.1 Advanced Study in Neurology Offered: Feb BIDMCE
2 NN501M.3 Advanced Neurology Offered: Feb MGH
3 NN505M.3 Pediatric Neurology Offered: Feb MGH
4 NN505M.7 Child Neurology Offered: Feb CHMC
5 PS530M.3 Lurie Ctr:Multidisciplinary Clinic for Children, Offered: Feb MGH
Adolescents & Adults w/ Autism Spectrum Disorder
6 ME556M.J Sleep Disorders Medicine Offered: Feb MULTI
7 ME529M.6 Clinical Management of the Addictions Offered: Feb CAM
8 ME540M.3 Outpatient Care of Patients w/ Down Syndrome Across Offered: Feb MGH
Age Spectrum
9 PA506.23 Clinical Clerkship in Neuropathology Offered: Feb BWH
10 NN503M.3 Advanced Study in Neuropathology Offered: Feb MGH
11 PS501M.10b Advanced Clerkship in Diagnosis & Treatment of Major Offered: Feb MCLH
Psychoses
12 PS507M.23 Women's Mental Health Offered: Feb BWH
13 ME513M.11 Clinical Infectious Disease Offered: Feb MTAH
14 ME501M.3 Advanced Medicine Clerkship Offered: Feb MGH
15 ME533M.J Understanding Lupus--A Multidisciplinary Approach to Offered: Feb MULTI
Systemic Disease

Current Medical School Information

Medical School Attending: Services Inst. of Medical Sciences, Pakistan


Expected Degree: MBBS
Expected Degree Date: 03/07/2019
Name of School Registrar: Prof.Dr.Mahmood Ayyaz

Print Date: 9/1/2018 1 of 2


HARVARD MEDICAL SCHOOL
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Exclerk Application Information


Title of School Registrar: Principal
Registrar Phone Number: +924299205517
Registrar Email: [email protected]
Mail To: Prof.Dr.Mahmood Ayyaz
Address Line 1: ghous-ul-azam, jail road, Lahore
Address Line 2:
City: Lahore
State:
Zip Code: 54000
Province: Punjab
Country: Pakistan

Mailing Address Permanent Address


Line 1: Shadman Colony, Sook Line 1: Shadman Colony, Sook
Line 2: House, H#A-91, S#A/3 Line 2: House, H#A-91, S#A/3
Line 3: Line 3:
City: Gujrat City: Gujrat
State: State:
Zip Code: 50700 Zip Code: 50700
Province: Province: Punjab
Country: Pakistan Country: Pakistan
Phone: +9253-3709162 Phone: +9253-3709162

Optional Information

Citizenship: Foreign National


Citizenship Country: Pakistan
(U.S. Only): Do you consider yourself to be Hispanic/Latino:
(U.S. Only): In Addition, select one of more of the following
racial categories to describe yourself:

Print Date: 9/1/2018 2 of 2

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