Certificate Course in Management of COPD & ASTHMA * Name *(In Block Letters)Current AffiliationPrivateGovernmentOtherIf other, please specifyCommunication AddressHouse NumberStreet NameCityPhoneMobilePreferred number for communicationEmail AddressEnter valid EmailDate Of BirthDate Of BirthSLMC Registration noPhotoChoose FileNo file chosenDelete uploaded filePass port sizeMedical Council Registration Certificate ( Upload file )Choose FileNo file chosenDelete uploaded fileMedical Council Registration CertificateCategoryMedicalRMOProvisionalCERTIFICATE COURSE IN EVIDENCE BASED DIABETES MANAGEMENT (CCEBDM)Educational / Academic / Technical / Professional QualificationsMBA Qualification Obtain FromQualification obtain yearRMO Qualification obtain fromQualification obtain yearDiploma qualification obtain fromQualification obtain yearMD Qualification obtain fromQualification obtain yearFellowship - (Organization Details)Certificate Program (Offered Organization)Qualification obtain yearAny Other detailsAverage number of patients treated in a monthAverage No. of patients with Diabetes seen in a month?Professional / Clinical ExperienceList Of Positions HeldList Of Organizations or Hospitals ServedList of service DurationsDateSignatureD E C L A R A T I O NSignatureDatePCDG Sri Lanka has the final decision on selecting the participants for this course.NamePlace Send Message
