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Substitute forms are not acceptable - This form may be duplicated as needed. Rhode Island Board of Pharmacy Room 205 Three Capitol Hill Providence RI 02908-5097 401 222-2837 PRECEPTOR AFFIDAVIT OF INTERNSHIP HOURS Applicant Should Complete this Section Only I hold a valid Limited License as a pharmacy intern and the Rhode Island Board of Pharmacy requires that this form be completed by each licensed pharmacist who served as my preceptor.
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How to fill out pharmacy preceptor ri form:

01
Obtain a copy of the pharmacy preceptor ri form from your pharmacy program or institution.
02
Carefully read through the instructions provided on the form to familiarize yourself with the requirements and guidelines for completion.
03
Fill in your personal information accurately, including your name, contact information, and any identification numbers required.
04
Provide information about your pharmacy education and professional background, including details about your degree, licensure, and any relevant certifications or training.
05
Indicate your availability and willingness to serve as a preceptor, including the specific time period and practice setting preferences.
06
Fill out any additional sections of the form that may pertain to your experience and skills as a pharmacy preceptor.
07
Review the completed form to ensure all fields are filled out correctly and all necessary information is included.
08
Sign and date the form, and submit it according to the instructions provided.

Who needs pharmacy preceptor ri form:

01
Individuals who are interested in serving as a preceptor in a pharmacy education program.
02
Pharmacy students or interns who are required to have a preceptor for their experiential training.
03
Licensed pharmacists who are seeking to enhance their professional development by mentoring pharmacy students or interns.
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The pharmacy preceptor ri form is a document that is used to report information about pharmacy preceptors. It is a form that is required by certain regulatory authorities to ensure compliance with pharmacy education requirements.
Pharmacy preceptors are typically required to file the pharmacy preceptor ri form. This includes individuals who are responsible for supervising and training pharmacy students or interns in a pharmacy setting.
To fill out the pharmacy preceptor ri form, you will need to provide the required information about the pharmacy preceptor, such as their name, contact information, and relevant qualifications or certifications. The form may also require information about the pharmacy or educational institution where the preceptor is affiliated.
The purpose of the pharmacy preceptor ri form is to ensure that pharmacy preceptors meet the necessary qualifications and requirements set by regulatory authorities. It serves as a way to monitor and assess the quality of pharmacy education programs and the effectiveness of preceptor supervision.
The information that must be reported on the pharmacy preceptor ri form typically includes the preceptor's name, contact information, professional qualifications or certifications, and details about their involvement in the pharmacy education program, such as the number of students or interns supervised.
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Related Links

Vasudha Gupta, PharmD - California Northstate University ...
Resources for Preceptors – College of Pharmacy
Access to University of Rhode Island College of Pharmacy's preceptor requirements, preceptor application forms, school specific training modules, etc.
Pharmacy Licensure Requirements by State
o Affidavit of Intern Experience Form completed by the preceptor and sent directly ... o Has completed 1500 hours of practical experience as a pharmacy intern ...

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