ࡱ> "$!@ LbjbjFF 00,,@ tttttttPPP8,,)!!!!;"%W)$*R"-{)t{)tt)!!!^tt!!!!!tt! @e@P< !!,)0)!-!^-!tttt-t!(!{){)Dd!" Q U E S T I O N N A I R E for host hospital interested in accepting Operating Room Personnel (ORP) as AO Fellows The purpose of the AO Fellowship is to offer interested Operating Room Personnel an opportunity to increase their knowledge of AO Technique. Should you be interested in offering a Fellowship placement in your hospital for a period of four, six or eight weeks, please complete this questionnaire and return it to AO International. 1. Information about the host hospital Name of the clinic/hospital: _____________________________________________ Year of construction: _____________________________________________ Number of Surgical theatres (O.R.): _____________________________________________ Number of orthopaedic/trauma O.R.: ____________________________________________ Number of Osteosynthesis/week approx.: _____________________________________________ Specialties: YES NO - Spine EMBED MSDraw \* mergeformat EMBED MSDraw \* mergeformat - Pelvic EMBED MSDraw \* mergeformat EMBED MSDraw \* mergeformat - Maxillo facial EMBED MSDraw \* mergeformat EMBED MSDraw \* mergeformat - paediatrics EMBED MSDraw \* mergeformat EMBED MSDraw \* mergeformat Central sterilisation dept.: ____________________________________________ Preparation of the instruments in the O.R.: ____________________________________________ 2. Personnel Surgical Head of orthopaedic/trauma department: ____________________________________________ ____________________________________________ Nursing Head of department: ____________________________________________ Number of ORP: ____________________________________________ Number of technical assistants: ____________________________________________ Number of students: ____________________________________________ Others: ____________________________________________ Languages spoken: English: EMBED MSDraw \* mergeformat French: EMBED MSDraw \* mergeformat Italian: EMBED MSDraw \* mergeformat Spanish: EMBED MSDraw \* mergeformat others: _______________ _____________________ Regular meetings/conferences or education of ORP within the hospital? __________________________________________________________________________ __________________________________________________________________________ 3. Accommodation for AO fellows Which possibilities exist? ____________________________________________ Cost per week? ____________________________________________ Are cooking facilities available? ____________________________________________ Telephone in the room? ____________________________________________ Telephone on the floor? ____________________________________________ Can meals be taken at the hospital canteen? ____________________________________________ Approx. cost per meal? ____________________________________________ 4. Travel of the AO fellows Which is the best way for the fellow coming from abroad to reach your hospital? (Please describe in a few words with indication of duration.) __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 5. Number of AO fellows Would you prefer to take one or two scholars at the same time? (It is much less stressful on the scholars and personnel when two are placed together.) __________________________________________________________________________ __________________________________________________________________________ 6. Administration Who will be responsible in your hospital for: Booking the accommodation: ____________________________________________ Welcoming + orientating the scholar: ____________________________________________ Handing over of the key of the room: ____________________________________________ Please submit name of bank and bank account no for the transfer of the stipend. ____________________________________________ Please return this questionnaire to: Susanne Buerle Director of ORP Education AO International Clavadelerstrasse CH-7270 Davos Platz Many thanks for your information and your assistance. Enclosure: 1 envelope addressed to AO International, Davos Platz PAGE3 !ovxz0 :  ׺׺׫ם׋v׋aO׋#jh8CJOJQJUmH sH )j94 h8CJOJQJUVmH sH )j94 h8CJOJQJUVmH sH #jh8CJOJQJUmH sH h=gCJOJQJmH sH h85CJOJQJmH sH hbtCJOJQJmH sH hQh5CJOJQJmH sH h8CJOJQJmH sH h85CJOJQJmH sH h8OJQJmH sH "#Iiwxyz =  fedh^e` J e^e` e^e` $&d P a$$a$ o#@K= & 1 } ~ . # C ~  h fe^e` fedh^e` * + , - @ A ^ _ ` a b c ƸƸƸƸ|jƸƸUCƸƸ#jh8CJOJQJUmH sH )j!94 h8CJOJQJUVmH sH #jh8CJOJQJUmH sH )j94 h8CJOJQJUVmH sH #jFh8CJOJQJUmH sH )j94 h8CJOJQJUVmH sH h8CJOJQJmH sH #jh8CJOJQJUmH sH #jh8CJOJQJUmH sH )j94 h8CJOJQJUVmH sH  ƸƸƸqƸ\JƸƸ#jh8CJOJQJUmH sH )j&94 h8CJOJQJUVmH sH  h85>*CJOJQJmH sH h85CJOJQJmH sH #jN h8CJOJQJUmH sH )j$94 h8CJOJQJUVmH sH h8CJOJQJmH sH #jh8CJOJQJUmH sH #j h8CJOJQJUmH sH )j#94 h8CJOJQJUVmH sH 5kl,[\;<\2w]^ f]e^e` f]edh^e` fedh^e`  ()*+<T[\^ryƸƸƸƸ|jƸ[L;[L h85>*CJOJQJmH sH hbt5CJOJQJmH sH h85CJOJQJmH sH #jVh8CJOJQJUmH sH )j*94 h8CJOJQJUVmH sH #jh8CJOJQJUmH sH )j)94 h8CJOJQJUVmH sH h8CJOJQJmH sH #jh8CJOJQJUmH sH #jh8CJOJQJUmH sH )j'94 h8CJOJQJUVmH sH ^z W;<=>V;e9: f]e^e` f]edh^e`y>NUVbq@AEFGHKLƵ򕑕h=gmHnHuh=gjh=gUh8CJOJQJhQhCJOJQJmH sH  h85>*CJOJQJmH sH hbt5CJOJQJmH sH h85CJOJQJmH sH hbtCJOJQJmH sH h8CJOJQJmH sH :;<abr ?@IJKL$a$ f]e^e` f]edh^e`. 00PP&P . A!4"#$%Dd 0  # A2>HK)YN[ D1`!HK)YN[~@@ xmPQ =_ZtBK+;eY,a,n؈٘hL9I8 Pjs&EVOɢ7x鍓0g3NRA@&'3'="6,d~C82Z: Ȳ {7NВD.Ѹܶa9F<₠,Ӭ]D'4جJ # / r,<Dd 0  # A2>HK)YN[ 1`!HK)YN[~@@ xmPQ =_ZtBK+;eY,a,n؈٘hL9I8 Pjs&EVOɢ7x鍓0g3NRA@&'3'="6,d~C82Z: Ȳ {7NВD.Ѹܶa9F<₠,Ӭ]D'4جJ # / r,<Dd 0  # A2>HK)YN[ 1`!HK)YN[~@@ xmPQ =_ZtBK+;eY,a,n؈٘hL9I8 Pjs&EVOɢ7x鍓0g3NRA@&'3'="6,d~C82Z: Ȳ {7NВD.Ѹܶa9F<₠,Ӭ]D'4جJ # / r,<Dd 0  # A2>HK)YN[ 1`!HK)YN[~@@ xmPQ =_ZtBK+;eY,a,n؈٘hL9I8 Pjs&EVOɢ7x鍓0g3NRA@&'3'="6,d~C82Z: Ȳ {7NВD.Ѹܶa9F<₠,Ӭ]D'4جJ # / r,<Dd 0  # A2>HK)YN[ L1`!HK)YN[~@@ xmPQ =_ZtBK+;eY,a,n؈٘hL9I8 Pjs&EVOɢ7x鍓0g3NRA@&'3'="6,d~C82Z: Ȳ {7NВD.Ѹܶa9F<₠,Ӭ]D'4جJ # / r,<Dd 0  # A2>HK)YN[  1`!HK)YN[~@@ xmPQ =_ZtBK+;eY,a,n؈٘hL9I8 Pjs&EVOɢ7x鍓0g3NRA@&'3'="6,d~C82Z: Ȳ {7NВD.Ѹܶa9F<₠,Ӭ]D'4جJ # / r,<Dd 0  # A2>HK)YN[ 1`!HK)YN[~@@ xmPQ =_ZtBK+;eY,a,n؈٘hL9I8 Pjs&EVOɢ7x鍓0g3NRA@&'3'="6,d~C82Z: Ȳ {7NВD.Ѹܶa9F<₠,Ӭ]D'4جJ # / r,<Dd 0  # A2>HK)YN[ 1`!HK)YN[~@@ xmPQ =_ZtBK+;eY,a,n؈٘hL9I8 Pjs&EVOɢ7x鍓0g3NRA@&'3'="6,d~C82Z: Ȳ {7NВD.Ѹܶa9F<₠,Ӭ]D'4جJ # / r,<Dd 0   # A2>HK)YN[ T1`!HK)YN[~@@ xmPQ =_ZtBK+;eY,a,n؈٘hL9I8 Pjs&EVOɢ7x鍓0g3NRA@&'3'="6,d~C82Z: Ȳ {7NВD.Ѹܶa9F<₠,Ӭ]D'4جJ # / r,<Dd   F#&B'()+*,-./0123465789:;<=>?A@CDEIJGHKMNOPQRSTUVWXYZ[\]^_`abRoot EntryA F2f@%(Data WordDocument@00ObjectPoolCe@2f@_876209429Fe@`e@Ole CompObjLObjInfo  !"#&)*+,-./256789:;>ABCDEFGJMNOPQRSVYZ[\]^_befghijknqrstuvwz}~ FMicrosoft DrawingMSDrawMSDraw  Z&MrEdMicrosoft DrawZ&MrEd| System)_  &Ole10Native_876209435 F`e@`e@Ole  CompObj LMrEd@@  @@  ''^&Gv^&wFVFVv h, u  FMicrosoft DrawingMSDrawMSDrawObjInfo Ole10Native_876209436F`e@`e@Ole   Z&MrEdMicrosoft DrawZ&MrEd| System)_  &MrEd@@  @@  ''^&Gv^&wFVFVv h, u  FMicrosoft DrawingMSDrawMSDraw  Z&MrEdMicrosoft DrawZ&MrEd| System)_  &CompObjLObjInfoOle10Native_876209438 'F`e@`e@MrEd@@  @@  ''^&Gv^&wFVFVv h, u  FMicrosoft DrawingMSDrawMSDrawOle $CompObj%LObjInfo'Ole10Native(  Z&MrEdMicrosoft DrawZ&MrEd| System)_  &MrEd@@  @@  ''^&Gv^&wFVFVv h, u _876209439F`e@`e@Ole 0CompObj1LObjInfo3 FMicrosoft DrawingMSDrawMSDraw  Z&MrEdMicrosoft DrawZ&MrEd| System)_  &Ole10Native4_876209441"F`e@`e@Ole <CompObj =LMrEd@@  @@  ''^&Gv^&wFVFVv h, u  FMicrosoft DrawingMSDrawMSDrawObjInfo!?Ole10Native@_876209443$F`e@`e@Ole H  Z&MrEdMicrosoft DrawZ&MrEd| System)_  &MrEd@@  @@  ''^&Gv^&wFVFVv h, u  FMicrosoft DrawingMSDrawMSDraw  Z&MrEdMicrosoft DrawZ&MrEd| System)_  &CompObj#%ILObjInfo&KOle10NativeL_8762094441)F`e@`e@MrEd@@  @@  ''^&Gv^&wFVFVv h, u  FMicrosoft DrawingMSDrawMSDrawOle TCompObj(*ULObjInfo+WOle10NativeX  Z&MrEdMicrosoft DrawZ&MrEd| System)_  &MrEd@@  @@  ''^&Gv^&wFVFVv h, u _876209446.F@e@@e@Ole `CompObj-/aLObjInfo0c FMicrosoft DrawingMSDrawMSDraw  Z&MrEdMicrosoft DrawZ&MrEd| System)_  &Ole10Natived_876209447,63F@e@@e@Ole lCompObj24mLMrEd@@  @@  ''^&Gv^&wFVFVv h, u  FMicrosoft DrawingMSDrawMSDrawObjInfo5oOle10Nativep_876209449;8F@e@@e@Ole x  Z&MrEdMicrosoft DrawZ&MrEd| System)_  &MrEd@@  @@  ''^&Gv^&wFVFVv h, u  FMicrosoft DrawingMSDrawMSDraw  Z&MrEdMicrosoft DrawZ&MrEd| System)_  &CompObj79yLObjInfo:{Ole10Native|_876209450=F@e@@e@MrEd@@  @@  ''^&Gv^&wFVFVv h, u  FMicrosoft DrawingMSDrawMSDrawOle CompObj<>LObjInfo?Ole10Native  Z&MrEdMicrosoft DrawZ&MrEd| System)_  &MrEd@@  @@  ''^&Gv^&wFVFVv h, u 0   # A 2>HK)YN[ 1`!HK)YN[~@@ xmPQ =_ZtBK+;eY,a,n؈٘hL9I8 Pjs&EVOɢ7x鍓0g3NRA@&'3'="6,d~C82Z: Ȳ {7NВD.Ѹܶa9F<₠,Ӭ]D'4جJ # / r,<Dd 0   # A 2>HK)YN[ 1`!HK)YN[~@@ xmPQ =_ZtBK+;eY,a,n؈٘hL9I8 Pjs&EVOɢ7x鍓0g3NRA@&'3'="6,d~C82Z: Ȳ {7NВD.Ѹܶa9F<₠,Ӭ]D'4جJ # / r,<Dd 0   # A 2>HK)YN[ 1`!HK)YN[~@@ xmPQ =_ZtBK+;eY,a,n؈٘hL9I8 Pjs&EVOɢ7x鍓0g3NRA@&'3'="6,d~C82Z: Ȳ {7NВD.Ѹܶa9F<₠,Ӭ]D'4جJ # / r,<1TableL-SummaryInformation(BDocumentSummaryInformation8HCompObjjOh+'0  ( D P \ ht|Q U E S T I O N N A I R E. U Giovannina JostioviovAOvadoenzi3oeMicrosoft Word 10.0@@Wj@؍@@N@\՜.+,0 px   AO-CENTER 8 Q U E S T I O N N A I R E Title  FMicrosoft Word Document MSWordDocWord.Document.89qH@H Normal5$7$8$9DH$_HmHsHtH DAD Default Paragraph FontViV  Table Normal :V 44 la (k(No List 4 @4 Footer  o#L0"#Iiwxyz =&1}~.#C~h5kl,[\; < \ 2 w  ] ^ z W ; < = > V ;e9:;<abr ?@IM000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000@0X "#Iiwxyz =&1}~.#C~h5kl,[\; < \ 2 w  ] ^ z W ; < = > V ;e9:;<abr ?@HIJM<;0<;0<;0<;0<;0<;0<;0<;0<;0j<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0>;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0>;0<;0<;0<;0<;0<;0<;0<;0<;0<;0>;0>;0<;0<;0<;0<;0<;0<;0<;0<;0>;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0>;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0<;0R>{0P 4ztK(t Dt `t |t <{0   yL = ^:LK  *,@^`b (*L:::::::::::: !2@18jq9>@JM!#'ikDF-3]3 I x @JM333333333333333%< ] > W br @JM%@JM=gQhbt8^ @JM@\\DA01FS01\public-aoiNe05:winspool\\DA01FS01\public-aoi\\DA01FS01\public-aoiS 4dPRIV0''''P4(\\DA01FS01\public-aoiS 4dPRIV0''''P4($LP@UnknownGz Times New Roman5Symbol3& z ArialCFormata Light"CV ssj\\V xx24883V H(?QhU:\WINWORD\DOT\AO.DOTQ U E S T I O N N A I R EGiovannina Jostadoenz