Medical Diploma specializing in Anesthesia Date obtained: University, town, country: Other medical training (ultrasound, Fast Echo, local/regional anesthesia, pain treatment, palliative care, teaching/training, public health, tropical medicine, ATLS, others...) Scan Table Trainings Practice regularly? - yes/no Type of Training/ year Echo Fast Echocardiogram vascular scan Local/regional anesthesia - neurostimulation Local/regional Anesthesia - scan Palliative care Pain treatment Teaching Others Professional Anesthetist Career Type of Activity (Pediatric, Trauma, Obstetrics, ICU, urgent care, Date Title/Function Hospital/town/country others) Other professional activities Type of Activity Date (start-end) Title/Function Name of company/town/country Miscellaneous Publications: Anesthetists References (2) Reference 1 Name: Profession: E-mail : Name: Profession: Telephone: Reference 2 E-mail : Telephone:
Medical Diploma specializing in Anesthesia Date obtained: University, town, country: Other medical training (ultrasound, Fast Echo, local/regional anesthesia, pain treatment, palliative care, teaching/training, public health, tropical medicine, ATLS, others...) Scan Table Trainings Type of Training/ year Practice regularly? - yes/no Echo Fast Echocardiogram vascular scan Local/regional anesthesia - neurostimulation Local/regional Anesthesia - scan Palliative care Pain treatment Teaching Others Professional Anesthetist Career Type of Activity (Pediatric, Trauma, Obstetrics, ICU, urgent care, others) Date Title/Function Hospital/town/country Other professional activities Type of Activity Date (start-end) Title/Function Name of company/town/country Miscellaneous Publications: Anesthetists References (2) Reference 1 Name: Profession: E-mail : Telephone: Reference 2 Name: Profession: E-mail : Telephone:
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