Hospital Nomination
Nominate a hospital that you believe qualifies for free medical software, DynaMed Plus
* Required
Email address
*
Your email
What is your first name?
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Your answer
What is your last name?
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Your answer
What is your email address?
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Your answer
Have you received PEMSoft or DynaMed Plus from KidsCareEverywhere in the past>
*
Yes, PEMSoft
Yes, DynaMed Plus
No, KCE has never been to this hospital
What is the name of the hospital you are nominating?
*
Your answer
What COUTRY is this hospital or medical school in?
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Your answer
What CITY is this hospital or medical school in?
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Your answer
How many physicians, residents, and/or medical students are there at this hospital or medical school?
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Your answer
What level of English proficiency do the physicians at this hospital/medical school have?
*
This question is important so that we can translate our training materials if necessary
Very comfortable with verbal/written English
Comfortable with WRITTEN English but uncomfortable with VERBAL English
Comfortable with VERBAL English but uncomfortable with WRITTEN English
NOT comfortable with verbal/written English
Other:
What type of mobile phone do most people use at this hospital?
*
iOS (iPhone)
Android
Other:
Does this hospital have access to Up-To-Date
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Yes
No
Maybe
Other:
What is your relationship to this hospital or medical school?
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Student
Resident
Attending physician
Faculty
Staff
Graduate
Other:
Please provide the contact information for the head of the hospital or medical school being nominated
Please provide their full name, title and email address. This information is needed so that we may contact them for further coordination and organization of a trip.
Your answer
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