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Institute Registration
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| ICU INFORMATION FORM |
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Name of the Institute
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Co-ordinator
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Designation
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Degree
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Speciality
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Address
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City
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Pincode
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State
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Country
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City Code
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Mobile No.
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Land-Line No.
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Fax No.
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Email Address
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| Details of Hospital |
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Type of Hospital
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No. of Hospital Beds
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Academic affiliation
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ICU Training Programmes
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Number of Annual Admissions in the Hospital
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| Details of ICU
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Type of ICU
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(non-ICU doctors may write orders)
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ICU speciality
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Number of ICU Beds |
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Number of Annual Adminissions in the ICU
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Number of Ventilators in your ICU
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Number of Ventilated cases per annum
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Number of Nurses in ICU per shift
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Number of Patients per Nurse in ICU
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| Facilities available in ICU/Hospital |
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No of ICU Consultants
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Full time
Part time
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| ICU Director |
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Name
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Degree
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Speciality
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Email Address
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The research committee of the ISCCM will be co-ordinating multicentric clinical trials /surveys from time to time. Would you be interested in participating in such a study
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Co-ordinator Signature
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