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Ams Confirmation

This document is a confirmation slip for an antimicrobial stewardship training program hosted by Bataan General Hospital & Medical Center from September 23-25, 2019. It requests that participants from level 1 hospitals include 2 physicians, 1 infection control nurse, and 1 clinical pharmacist. The confirmation slip must be completed and submitted by September 6, 2019 to register the hospital's participants. It also includes spaces to provide each participant's name, designation, contact information, and any restrictions. The chief of the sending hospital must sign to endorse sending the listed participants to the training.

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R'mon Ian Castro Santos
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240 views1 page

Ams Confirmation

This document is a confirmation slip for an antimicrobial stewardship training program hosted by Bataan General Hospital & Medical Center from September 23-25, 2019. It requests that participants from level 1 hospitals include 2 physicians, 1 infection control nurse, and 1 clinical pharmacist. The confirmation slip must be completed and submitted by September 6, 2019 to register the hospital's participants. It also includes spaces to provide each participant's name, designation, contact information, and any restrictions. The chief of the sending hospital must sign to endorse sending the listed participants to the training.

Uploaded by

R'mon Ian Castro Santos
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines

Department of Health | Regional Office 3

BATAAN GENERAL HOSPITAL & MEDICAL CENTER


City of Balanga, Bataan
ISO-QMS: 9001 Certified

CONFIRMATION SLIP

ACTIVITY: ANTIMICROBIAL STEWARDSHIP (AMS) TRAINING PROGRAM


FOR LEVEL I HOSPITALS

DATE: September 23-25, 2019

VENUE: The Plaza Hotel, Balanga City, Bataan

Reminder: Participants should be (2) Physicians, (1) Infection Control Nurse and (1)
Pharmacist with experience in clinical pharmacy.
2019
ANTIMICROBIAL
STEWARDSHIP
Please completely fill out the confirmation slip and submit through email
TRAINING ams.bghmc@gmail.com , not later than September 6, 2019.
Sept. 23-25, 2019

ANTIMICROBIAL
STEWARDSHIP COMMITTEE:
PARTICIPANT’S INFORMATION
Anne Louise Gabriel-Chan,MD
Overall Chair Name of Hospital:

Restrictions
Maria Ines Betina L. Santos, MD
Overall Co-Chair Name & Signature Mobile No. /
No. Designation Email Address Gender (e.g. food
Johnson D. Palaypay, RN of Participant allergies)
Overall Secretary

Members:
Vladimir Untalan, MD
Allen Andrew Sy, MD
Jocelyn Bongco, MD
Noel Laxamana, MD
Darlene Minette Zamora, MD
Don Arlie Romero, MD
Jerry James Bunagan, MD
Odysseus Chan, MD

ANTIMICROBIAL
STEWARDSHIP TEAM:
Non-IDS Doctors:
Maria Almira Kiat, MD
Jocelyn Bongco, MD
Rely Ann Ronquillo, MD
Albertson Gumarao, MD
* Kindly write legibly, this will be used as basis for training certificates with CPD units.
Members:
Joy Andres, RPh Respectfully endorsing the above-mentioned participant/s to attend the ANTIMICROBIAL
Evelyn Rubia, RN
Sarah Bartolo, RMT STEWARDSHIP (AMS) TRAINING PROGRAM FOR LEVEL I HOSPITALS
Czarina Lintag, RMT
Rae Madelaine Laxa, RPh on September 23-25, 2019 at The Plaza Hotel, Balanga City, Bataan.
Paolo Nuestro
Ma. Teresa Miguel, RN
Melody Flores, RMT
Elionore Pizarro, RPh
___________________________________________________
NAME AND SIGNATURE OF CHIEF OF HOSPITAL

*For inquiries, contact us at (047) 237-1274 loc. 211 or 09175293053, and look for Ms. Joy
Andres, BGHMC-AMS Team Member.
Mailing Address: Manahan Street, Tenejero,
Balanga City, Bataan, 2100 Philippines
Telephone no.: (047) 237-1274 loc. 103
E-mail: ams.bghmc@gmail.com
Website: bataangeneralhospital.doh.gov.ph

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