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Reference Request Drs

This document is a reference request form completed by Dr. Sohail Farooq for Musab Bin Umair, who worked as a medical officer from October 2019 to October 2020 at Ali Ahmad Khan Hospital, where Dr. Farooq rates Bin Umair's clinical and interpersonal skills as meeting expectations and says he would re-employ him, describing him as an energetic young doctor with good clinical abilities.

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Talha Latif
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79 views1 page

Reference Request Drs

This document is a reference request form completed by Dr. Sohail Farooq for Musab Bin Umair, who worked as a medical officer from October 2019 to October 2020 at Ali Ahmad Khan Hospital, where Dr. Farooq rates Bin Umair's clinical and interpersonal skills as meeting expectations and says he would re-employ him, describing him as an energetic young doctor with good clinical abilities.

Uploaded by

Talha Latif
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

Urgent - Reference Request FAX NUMBER 01277 246 850

Contact Details to return references


Dr. Sohail Farooq
Referee Name:
Email: [email protected]
Position of referee: Consultant Physician Please make sure that this is not sent from a
private email account.
Hospital: Ali Ahmad Khan Hospital
Fax: 01277 246 850
Date Requested: 16-04-2021 Fax/ Email: [email protected]

Post: ProMedical, The Granary, 4-6 Crescent


Applicant’s Name: Musab Bin Umair
Road, Brentwood, Essex, CM14 5JR
GMC Number: 76300 Grade/ Spec: Medical Officer
All written references need to be on headed
paper addressed to ProMedical, signed &
Employment Dates: Start: OCT-2019 End: OCT-2020
include dates of employment.
By signing this reference you will be agreeing to the above dates of employment
if these are incorrect please state here: Start End

Compliance Officer:

Please tick below in regards to the applicant:

Clinical Skills Exceeds expectations ✔ Meets Expectations Below Expectations

History Taking/ Administration Exceeds expectations ✔ Meets Expectations Below Expectations

Physical Examination Exceeds expectations ✔ Meets Expectations Below Expectations

Investigation & Diagnosis Exceeds expectations ✔ Meets Expectations Below Expectations

Judgment & Patient Management Exceeds expectations ✔ Meets Expectations Below Expectations

Reliability/ Punctuality Exceeds expectations ✔ Meets Expectations Below Expectations

Relation with Colleagues Exceeds expectations ✔ Meets Expectations Below Expectations

Relation with Patients Exceeds expectations ✔ Meets Expectations Below Expectations

Appearance Exceeds expectations ✔ Meets Expectations Below Expectations

Communication Skills – Written Exceeds expectations ✔ Meets Expectations Below Expectations

Below Expectations
Communication Skills – Verbal Exceeds expectations ✔ Meets Expectations

Would you re-employ this candidate? ✔ Yes No

Additional Comments: Musab Bin Umair did a very good job with me at Ali Ahmad Khan Hospital. He is an energetic
young doctor with very good clinical skills.

By signing this reference you agree for it to be passed onto a 3rd party such as an NHS Trust for employment and audit purposes and agree to the
dates of employment as stated above.

Print Full Name: Dr. Sohail Farooq GMC No:

Grade: Speciality: Internal Medicine


Consultant
Signature/PP
And Hospital Date Signed: 19-04-21
Stamp:

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