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Certificate Program On Hospital Infection Control Application Form PDF

The document is an application form for a certificate program on hospital infection control run by The Sankara Nethralaya Academy. It requests applicant details such as name, age, gender, contact information, qualifications, designation, department, years of experience and role in hospital infection control. It also requests organization details for those applying on behalf of an organization.

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dew23
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371 views1 page

Certificate Program On Hospital Infection Control Application Form PDF

The document is an application form for a certificate program on hospital infection control run by The Sankara Nethralaya Academy. It requests applicant details such as name, age, gender, contact information, qualifications, designation, department, years of experience and role in hospital infection control. It also requests organization details for those applying on behalf of an organization.

Uploaded by

dew23
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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THE SANKARA NETHRALAYA ACADEMY

(Unit of Medical Research Foundation)

CERTIFICATE PROGRAM ON HOSPITAL INFECTION


CONTROL
Application form to be filled in block letters
APPLICANT DETAILS
Candidate Name

Age

..

Phone No

Email ID: ..................................

Address

Gender: M / F (Please tick)

.
Qualification

...

Designation

...

Department / Unit :

...

Role in HIC

Years of experience:

...

Nature of activities:

.
ORGANISATION DETAILS

Organization Name :

Address

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