CEEA Course Report

CEEA Course Report

To be completed by Course Director on behalf of CEEA Centre Director
CEEA's Center*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Director's Name*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
The Past Course*

1. Thorax and Respiration2. Heart and Circulation3. Intensive Care, Emergency Medicine, Blood and Blood Transfusion4. Mother and Child. Adverse Reactions5. Neurology, Regional Anaesthesia and Pain Management6. Specific Domains of Perioperative Medicine
Started Date of the course*

DayMonthYear
Ended date of the course*

DayMonthYear
Number of Participants*
Which evaluation has the participant completed*

MCQConcordant Test ScriptGlobal Clinical Case DiscussionRisk Management SessionNo evaluation
The Lectures have been evaluated*

YesNo
Should be Empty: