» Applicationform Anatomical preparations

Request form Anatomical preparations

Application form for education with anatomical preparations on behalf of third parties

Start date*
Year
Month
Day
End date*
Year
Month
Day
Applicant*
Location course*
Data applicant
Name main applicant*
First name Last name
Position*
Coorperation with a company*
- Yes
- No
Remarks coorperation
Department*
Hospital*
Adress*
Street Address City ZIP / Postal code Country
Telephone number*
Email*
Costcode*
Group composition*
Specialists (1) PhD's (2) Other (1)
(1) Please indicate how many participants are employed at the UMCG. (2) Please indicate how many participants are employed at the UMCG or in a training hospital affiliated with the UMCG.
Educational purpose
Educational purpose and name of the procedure*
Purpose of the procedure*
- Practice existing procedure
- Development existing procedure
- Studying operation area/anatomy
*Apply applicable
Preparations
Preparations*
- Thiel
Preparations*
- Fresh/frozen
- Fixated
Number of interventions/preparations
Disclaimer*
This application concerns bodies or parts of bodies that come from the Groningen body donation program. The donors agree that their bodies are used for education and research purposes by means of a will. The Section Anatomy is responsible for the correct execution of the body donation program, and evaluates each application before it release’s bodies from its program for the relevant activity. An approved application does not means that the Section Anatomy can guarantee that sufficient bodies or parts of bodies are available. In the case of shortage of available bodies, regular education – the curriculum Medicine (Bachelor and Master) and the resident education of the common trunk-takes precede. Large applications requiring a lot of bodies need to take a longer plan time into account. The use of bodies from the body donation program may be charged. Cancellation of the application as well. All personal data will be used strictly for administrative purposes and may be revoked at any time. I have understood the above
- OK
Phone
This field is for validation purposes and should be left unchanged.

Applicationform Anatomical preparations

Request form Anatomical preparations

Data applicant

Educational purpose

Preparations

Your browser is out-of-date!