Blue Blood, True Blood: Conflict & CreationFull description
Blue Blood, True Blood: Conflict & CreationDescripción completa
Yash Chopda, Nirmal Jain, ShreyasNair , Ved Gindodia Abstract: The aim of our project is to save lives of people by providing blood to them whenever required. Our project i.e Blood Donation App...
Blood Brothers by Wiley Russell = play versionFull description
Full description
Preguntas de análisisDescripción completa
Preguntas de análisisDescripción completa
aptitude questions on blood relations
An extraordinarily in-depth look at the blood “libel”–the centuries-long act of jews kidnapping, murdering, and ritualistically draining the blood of Christian children to be kneaded into th…Full description
PhlebotomyDescripción completa
Blood Magic
blood bank discription
This study was conducted to provide a possible solution to the unceasing problem of finding willing blood donors with the use of mobile technology and location based services. The blood donor finder application aimed to provide a means to easily loca
Classification According to Ownership : [ ] Government
[ ] Private
Institutional Character : [ ] Hospital Based
[ ] Non-hospital Based
Service Capability
: [ ] BCU
[ ] BS
: [ ] Initial
[ ] Renewal License No. ________________ Date Issued ________________ Expiry Date ________________
Status of Application
Checklist of Application Documents Please tick () the appropriate boxes under column B or C. Shaded Items are not required. A B C Documents For Initial For Renewal 1. Notarized Application for Authority to Operate a BCU/ BS (this form) Submit 2. List of Personnel (attached form) changes only 3. Photocopies of the following: 3.1. Proof of qualification of the medical and paramedical staff Valid PRC ID Specialty Board Certificate of the medical staff Certificate of Training/ Record of Work Experience 3.2. Proof of employment of the medical, paramedical and administrative staff Submit 4. List of Equipment/ Instrument (attached form) changes only 5. Health Facility Geographic Form (Location Map) Submit 6. Floor Layout changes only 7. SEC/ DTI Registration (for private BCU/ BS) OR Issuance or Board Resolution (for government BCU/ BS) Submit 8. Quality Manual of BCU/ BS changes only 9. NVBSP Annual Blood Report 10. Certificate of Inclusion in the Regional Blood Services Network approved by the identified Lead Blood Center in the region Form-BSF-ATO-A Revision:01 12/03/2014 Page 1 of 5
Acknowledgement REPUBLIC OF THE PHILIPPINES ) CITY/ MUNICIPALITY OF ______________ ) S.S.
I,
______________________________, ____________, of legal age, __________, a resident of Civil Status Age Name ___________________________________________, after having been sworn in accordance with law hereby depose Address and say that I am executing this affidavit to attest to the completeness and truth of the foregoing information and the attached documents required for the licensure and regulation of blood service facilities in the Philippines pursuant to Administrative Order No. 2008-0008 “Rules and Regulations Governing the Regulation of Blood Service Facilities”.
_________________________ Signature
Before me, this _________day of ______________ 20
in the City/ Municipality of ________________,
Philippines, personally appeared
Owner _______________________________
Community Tax Number
Issued at/ on
_________________________
_________________________
known to me to be the same person/s who executed the foregoing instrument and they acknowledge to me that the same is their free act and deed.
IN WITNESS WHEREOF, I have hereunto set my hands this _________day of _______________ 20
Doc. No. _____________________ Page No. ____________________ Book No. ____________________ Series of ____________________
NOTARY PUBLIC My Commission Expires Dec. 31, _______
Form-BSF-ATO-A Revision:01 12/03/2014 Page 2 of 5
APPLICATION AS HEAD OF BLOOD COLLECTING UNIT/ BLOOD STATION The Director Health Facilities and Services Regulatory Bureau/DOH-Regional Office DOH Manila/ Regional Office Sir, In compliance with the requirements of Republic Act (RA) No. 7719 and Administrative Order (AO) No. 2008-0008, I have the honor to apply as head of: _________________________________________ Name of Blood Collecting Unit/ Blood Station _________________________________________ Address of Blood Collecting Unit/ Blood Station I. Name of Applicant: ______________________________________________________ Landline No.: ________________________ Mobile No.: _______________________ Address: ______________________________________________________________ II. Education and Training (Use additional sheets if necessary): Medical School/ Institution _____________________________________________ Inclusive Dates/ Year Graduated ________________________________________ Specialty Board 1 PBP Anatomic Pathology PBP Clinical Pathology PBP Anatomic and Clinical Pathology PSHBT2 Others: Specify
Date Certified
Training Institution
III. List all Blood Collection Units/ Blood Stations supervised/ headed or associated with: Name and Address of BCU/ BS A. As Head B. As Associate
Working Time
Work Schedule
I hereby certify that the foregoing statements are true. I assume full responsibility that the operation of the Blood Collection Unit/ Blood Station is in accordance with the Rules and Regulations pursuant to RA 7719 and AO No. 2008-0008. ______________________________ Signature over Printed Name Date 1 2
PBP – Philippine Board of Pathology PSHBT – Philippine Society for Hematology and Blood Transfusion Form-BCU_BS-Head-A Revision:01 12/03/2014
List of Personnel Name of BCU/ BS Address of BCU/ BS
