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Certificate Course in Integrated Geriatric Care (CCIGC)
*Mandatory to be filled.
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Gender
*
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Date of Birth
*
Current Affiliation
*
Private Practice
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Type of Registration *
MCI
State Medical Council
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*
Highest Qualification (Attach Proof)
*
Qualification
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Year
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Total professional/clinical experience (in years)
*
Experience Details
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Communication Address*
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Preferred mailing address
Place of Work
Residence
Email Address
*
Mobile Number
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WhatsApp Number
*
Number of patients with Geriatric Care ‘Treated’ or ‘Managed
*
Have you attended any other PHFI course?
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City
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State
*
I hereby declare that the above mentioned information, which I have provided, is true to the best of my knowledge. I shall participate in the E-learning CCIGC and will devote self-reading time for the entire five modules and participate in the assessments, organized by the offering institution. I also give my consent for publishing my feedback/testimonial which I forward to the Secretariat in any report or publication produced by PHFI. I understand that CCIGC is not a degree but only a E-learning course with the objective of training Primary care physician in prevention and management of Geriatric care and successful participants are not entitled to mention/call themselves as Geriatric care Specialist anywhere after completion of this course. I also understand that this certificate course is not recognised Medical Qualification, under section 11 (1) of the Indian Medical Council Act 1956 and the Institution offering this course is neither a medical college or a university nor offering the course in accordance with the provisions of the Indian Medical Act of the University Grants Commission Act.