2018 Paed & Neonatal Ventilation Registration form
Surname with initials (as it appears on certificate) *
Your answer
First name
Your answer
Mobile Number (0777628121) *
Your answer
Your e -mail *
Your answer
NIC Number (266541645V) *
Your answer
Designation *
Specialty – *
Place of work - Hospital *
Place of work - Unit *
Place of work - PICU
Place of work - NICU
Please indicate the hospital, If you have not tick PICU or NICU
Your answer
Province *
Have you attended to a formal full day ventilation course before *
Are you using HFOV in your unit *
Have you had formal training on HFOV *
Number of years you have handled ventilators *
Type of ventilator modes being used *
Have you been using following brands of ventilators (tick more than one option) *
Your meals preference *
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