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SPINECOR°
SpineCor Training Program for Paediatric & Adult Brace Providers
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ATTENDANCE FORM
P"ERSONA DETAILS (T”his"i”'s the name that / appear on your certificate)
_
Name: Diniah Utami
(First)
Title: MD
(Initial)
(Family)
Qualification:. PMR Resident................................................
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COMPANY/HOSPITAL DETAILS
(CO. CPO. PT. DR. DC)
_
Name: RSUPN Cipto Mangunkusumo...........................................................................
Address: Jl. Diponegoro No 71 Jakarta Pusat.
State:.DKI Jakarta...................................... Zip Code: 10430.............................. Country: Indonesia
Telephone#: (021) 1500135................................Cell#:................................................................
Email Address: ...........
PLEASE COMPLETE THE REVERSE OF THIS FORM AND RETURN
TO THE SPINECOR TRAINER
Date of Training Program:
Venue:
Pass mark achieved:
Case 1
Case 2
Case 3
Case 4
Case 5
SpineCor Phase 1 Training Program Certificate Awarded
Yes/No
Signed: ........................................................................................Date: ................ ......................
Millennium House, Peak Business Park, Foxwood Road, Chesteffeld, 541 9RF, United hingdom
% + 44 1246 455381 - + 44 1246 453701
[email protected] @ www.spinecor.com
iD The SpineCorporation Limited. All Rights Reserved
SpineCor Training Program for Paediatric & Adult Brace Providers
mmmmmovem ent is life...
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Delegates Course Feed Back
a.
Did the course satisfy your learning objectives? Yes
b.
Did you find any part of the course unclear of you felt that you required more
time? No
c.
What portion of the course did you gain the most benefit from? Patophysiologi and
clinical assesment
d.
What portion of the course did you gain the least benefit from? I think all of the course very
useful
e.
Do you feel sufficiently confident to take Phase 2 training (real patient
treatment with supervision and support)? I want to, but since i’m still in
residency, I’m afraid I don’t have enough time to do it in this 6 month
f.
Trainer feedback I love the way dr. Fong explain all the course. He is
very enthusiastic and mastering scoliosis so well
g.
General comments : overall it’s very excellent course, but I think it
would be better if the course divided in two days, because it’s little hard
to stay in front of laptop for almost 7 hours 😊
Millennium House, Peak Business Park, Foxwood Road, Chesterfield, 541 9RF, United Kingdom
^•“ + 44 1246 455381 +44 1246 453701 [email protected] °'g www.spinecor.com
0 The SpineCafporation Limited. All Rights Reserved