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APSA application form

Personal information
First name
Middle name
Last name

Profession
Address
E-mail
Telephone
Mobile

Relevant qualifications(recent three)
1.
2.
3.

Membership type
Individual Organizational

Patient Safety interests(top three)
Awareness and Reporting
Patient and public involvement
Risk assessment
Safety measurement / medical files
Diagnostic errors
Surgical errors
Medication errors
Communication / handover errors
Human factor engineering errors
Nosocomial infection
Others(specify)

Password This password will be used to modify or remove your application.
 
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