“The certificate course in evidence-based diabetes management” * Name *(In Block Letters)Current AffiliationPrivateGovernmentOtherIf other, please specifyCommunication AddressHouse NumberStreet NameCityPhoneMobilePreferred number for communicationEmail AddressEnter valid EmailDate Of Birth *Date Of BirthSLMC Registration NoMedical 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
