A.G. Holley State Hospital
Grand Rounds

 

Topic: "Florida Tuberculosis 2002 – A Vision into the Future"

"Public Health in the Control of Infectious Disease"

Speakers:

Date: Wednesday, April 10, 2002

Place: Auditorium, A.G. Holley State Hospital, 1199 W. Lantana Road, Lantana, Fl.

Time: 10:00 a.m. – 12:00 p.m. (EST)

Objectives: By the completion of the presentation, participants will be able to:

Lunch: Provided- 12:00 p.m. (Reservation must be made by April 4, 2002)

Sponsors: Florida AHEC Network and Everglades Area Health Education Center, Inc.

Program also supported by: A. G. Holley State Hospital, American Lung Association of Florida, Inc., Florida Bureaus of TB and Refugee Health and Laboratories

Registration: By phone: (561)540-3364 SC: 256-3364 fax: (561) 540-3366 or SC: 256-3366

Email: Affette_McIntosh@doh.state.fl.us the registration form- only required if attending in person.

 

TB Training Registration Form

(Please fax to Affette (Melody) McIntosh

A.G. Holley State Hospital at (561) 540-3366

Problems/Questions-call (561) 540-3364

Please Print Neatly

 

Name __________________________________________________________

Agency___________________________ Title__________________________

Phone ( )_______________ SC ( )___________ Fax ( )____________

Address_________________________________________________________

City______________________________ State_______ ZIP ___________

E-mail Address___________________________________________________

SSN#______________________ (required of non-Dept. of Health employees)

License Type: ______________ License #: _________________

 

Organization/Office: (Check one)

County / State Health Dept. Hospital HMO

Private Medical Office Nursing Home, Correctional Facility

Individual Other, specify____________________________

 

Position: (Check one)

MD/DO PA/ARNP RN LPN

Health/Family Service Rep. Administrative Staff Support Staff

Computer/Data Staff Educator Lab Staff

Respiratory Care Staff Nutrition Staff Pharmacy Staff

Other, specify______________________________

 

Education Level: (Check highest level attained)

High School Associate Bachelors

Masters Doctorate Post Doctorate

Business/Technical/Vocational Other, specify_______________________

 

Training Registration: Please specify

 

Comprehensive Clinical TB Course _________________________________________

Quarterly Grand Rounds _ April 10, 2002 A. G. Holley Hospital - Lantana

TB Skin Testing-Train-the-Trainer ________________________________________

TB Skin Testing-Certification Class ________________________________________

Collaborative Case Conference ________________________________________

Satellite Teleconference ________________________________________

Other, specify_________________ ________________________________________

 

Please visit our web site at http://www.doh.state.fl.us and choose Tuberculosis, Training Opportunities for course descriptions, dates and locations

Note: We are working on an on-line registration form for future programs.