Hospital Demographics

Please take a moment to help us update our records so that you continue to receive notices about area events and meeting. Thank you! The Baltimore-Chesapeake Point-of-Care Coordinators.

Name:
Title:
Institution:
Address:
City:
State:
Zip:
Phone:
Fax:
Email Address:
Please check all tests that currently part of your Point-of-Care testing program:	Glucose Pregnancy testing Spun hematocrit Drugs of Abuse Hemoglobin Urine dipsticks Cholesterol testing Urine specific gravity Fecal/Gastric Occult blood Blood gases Coagulation testing PT Coagulation testing aPTT Coagulation testing ACT Electrolytes Streptococcus Screen Monospot test Nitrazine pH (pH paper) BNP Amniotest Cardiac Markers- Troponin I KOH/Wet Mounts Troponin T Fern Testing
Has your Point-of-Care testing committee expanded to include any new departments/disciplines?	Yes No
If yes, what disciplines and departments make up this committee? (check all that apply)	Laboratory Hospital Administration Nursing and nursing education Materials Management Quality Improvement Officer Infection Control Medical Staff Legal Affairs
If you know someone, who you work with, who we can add to the invitation list, please provide their name, phone number, etc. below. We would like everyone who is interested in Point-of Care Testing to be included in future meetings.
What topics would you like to discuss that you feel would help you in the workplace?
Additional Comments:

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