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Critical Care Essentials for Nurses & Allied Health Staff
Registration form
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Full Name
*
Your answer
Email
*
Your answer
Gender
*
Male
Female
How did you learn about this course?
*
Facebook
Twitter
Google Search
Tele-ICU Website
Word of Mouth (Friend or Acquaintance Referral)
Email
Instagram
WhatsApp
Other:
Basic Qualification
*
Your answer
Postgraduate Education
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Your answer
Specialty
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Internal Medicine
Anesthesiology
Critical Care/Intensive Care
Physiotherapy
Cardiology
Pulmonology
Pediatrics
Family Medicine
Emergency Medicine
Oncology
Other:
Years of experience in the medical field.
*
Your answer
Do you currently work or plan to work in ICU/HDU?
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Yes
No
Years of experience in ICU.
*
Your answer
Designation / Title
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Medical Officer
Professor/Consultant Physician
House Officer/Intern
Trainee/Post Graduate Trainee
Physiotherapist
Technologist/Technician
Registrar
Nurse
Medical Student
Nursing Student
Other:
Name of Institution/Department (Affiliation)
*
Your answer
Type of Institution
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Federal Government
Provincial Government
City Government
Private
Semi-Private
Charitable/Trust
City
*
Your answer
Province
*
Sindh
Punjab
KPK
Balochistan
Other:
Contact No (Please provide the number that is active on WhatsApp)
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Your answer
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