Register Course Form

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​Register Your Course

Instructor First Name *


Date Format


Course Date

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Instructor Last Name


Discipline


Instructor E-mail Address


Address 1


Address 2


City


State


Postal Code


Country Where Facilitator Lives


Telephone


Country Where Course Was Taught


Language


Lessons Learned *


Teaching Method


Course Conducted


Doctor - Total Number Taught by Discipline


Nurse - Total Number Taught by Discipline


Midwife - Total Number Taught by Discipline


Birth Attendant - Total Number Taught by Discipline


Other - Total Number Taught by Discipline


Doctor - Knowledge Check Number Passed


Nurse - Knowledge Check Number Passed


Midwife - Knowledge Check Number Passed


Birth Attendant - Knowledge Check Number Passed


Other - Knowledge Check Number Passed


Doctor - Bag Mask Skill Number Passed


Nurse - Bag Mask Skill Number Passed


Midwife - Bag Mask Skill Number Passed


Birth Attendant - Bag Mask Skill Number Passed


Other - Bag Mask Skill Number Passed


Doctor - OSCE Station A Number Passed


Nurse - OSCE Station A Number Passed


Midwife - OSCE Station A Number Passed


Birth Attendant - OSCE Station A Number Passed


Other - OSCE Station A Number Passed


Doctor - OSCE Station B Number Passed


Nurse - OSCE Station B Number Passed


Midwife - OSCE Station B Number Passed


Birth Attendant - OSCE Station B Number Passed


Other - OSCE Station B Number Passed


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