List of Personnel: Annex A
List of Personnel: Annex A
List of Personnel
Name of Hospital
Address of Hospital
:_____________________________________________________________________________________________
:_____________________________________________________________________________________________
Name
Designation/ Position
Highest Educational
Attainment
PRC Reg.
No.
Valid
From
To
Signature
ANNEX B
List of Equipment
Name of Hospital
Address of Hospital
:_____________________________________________________________________________________________
:_____________________________________________________________________________________________
Serial No.
Equipment should be present, functional, and owned by the hospital applying for license to operate.
Quantity
Date of Purchase