Phs 7047-2026

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The document is a certification form for clinical practice hours completed by officers of the Public Health Service Commissioned Corps at accredited healthcare facilities or during deployments. It includes sections for personal identification, details of clinical hours, and a certification statement affirming the accuracy of the information provided. Additionally, it contains a Privacy Act Notice outlining the collection and use of personal information related to clinical practice hours.

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Click ‘Get Form’ to open the phs 7047 in the editor.
Begin by filling out the Identification section. Enter your grade/rank, full name, organization, duty phone number, mobile number, PHS serial number, email, specialty, and category.
In the Clinical Hours section, input the total number of clinical hours completed along with the start and end dates for these hours.
Document your clinical practice by providing details for each facility or deployment. Include city/state location, name of the health care facility, dates of clinical hours, number of clinical hours completed, name and signature of the clinical supervisor, and a description of care rendered.
Finally, complete the Certification section by signing and dating it. Ensure that both you and your supervisor provide printed names and signatures.

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