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CPDD-02 Application For CPD Program

Requirments

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Darnel Jasper Hurtado
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24 views

CPDD-02 Application For CPD Program

Requirments

Uploaded by

Darnel Jasper Hurtado
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Professional Regulation Commission

APPLICATION FOR ACCREDITATION OF CPD PROGRAM

CPD COUNCIL OF/FOR ________________________

Part I. General Information


Name of Provider:
Accreditation No.: MED-2020-031 Expiration Date: OCTOBER 30, 2023
Contact Person: Hermenegildo Jose B. Zialcita, MD Designation:
Head, Postgraduate Course Committee
Contact No.: +639285048699 E-mail add.: [email protected] Date of Application:

Proposed Program: Symposium

Conference Seminar Online Learning


Convention Workshop Educational/Study Tour
Forum Training Program Others: _____________
Title of the Program:
“ MMC Urologic Cancer Care: Surgical and Non-Surgical Cutting-edge Approach”.
Date to be offered: October 30, 2023 Duration: 4 hours Time: 0900H - 1300H

Venue and Address: No. of times program to be conducted:


Auditorium Tower 2 8th Floor Makati Medical Center First
Course Description:
This course aims to cover comprehensive discussions about surgical and robotic surgery in urology, as well as
advances in non-surgical and therapeutic options in urologic oncology.
Objectives:
- To discuss the vision of the Medical Center Section of Urology in actively pursuing cutting-edge technology and
advances in urology
- To strengthen and elevate the standards of care.
- To emphasize the importance of multidisciplinary cancer care by inviting subspecialists in cancer care,
including but not limited to surgery, medical oncology, pain and palliative care, radiation oncology, and
pathology.
Number of Target Participants: 70 participants Registration fee to be collected:
Free of charge
Part II. Acknowledgment
I hereby certify that the above information written by me are true and correct to the best of my knowledge
and belief. I further authorize PRC and other agencies to investigate the authenticity of all the documents
presented.

I am agreeing to the PRC Privacy Notice and giving my consent to the collection and processing of my
personal data in accordance thereto.
MARIA ROSARIO P. MARIN, MD
(Signature Over Printed Name)

DIRECTOR, DIVISION OF MEDICAL EDUCATION AND RESEARCH


Position
_____________________
Date
Part III. Assessment
Regulation Division: Cash Division:
Assessed by : ___________________ Amount : ___________ O.R. No.: ____________
Date : ___________________ Date : ____________________
Remarks : ___________________ Issued by : ____________________
Part IV. Action taken by the CPD Council

CPDD-02
Rev. 04
June 29, 2020
Page 1 of 2
Approved for _____ credit units Accreditation No. _______________
Deferred pending compliance ____________________________________
_ ___________________________________________________________
Disapproved due to ____________________________________________
____________________________________________________________

_____________________________
Chairperson

____________________________ _____________________________
Member Member
Date:____________________

PROCEDURE FOR ACCREDITATION OF CPD PROGRAM


Step 1. Secure application form at Regulations Division of any of the PRC Regional Offices or download at
PRC website (www.prc.gov.ph).
Step 2. Fill-out Application Form and attach supporting documents listed hereunder. Provide one (1)
set for receiving copy.
Step 3. Proceed to Regulations Division of any of the PRC Regional Offices for checking and assessment.
Step 4. If the assessment is favorable, pay prescribed fee of One Thousand Pesos (₱ 1,000.00) per
program offering. Government agencies and instrumentalities offering CPD Programs free of
charge, do not have to pay a fee. If not favorable, go back to Step 3.
Step 5. Submit Application Form with attached supporting documents and photocopy of official receipt to
Regulations Division of any of the PRC Regional Offices, at least fifteen (15) working days prior to
offering.
Step 6. Follow-up the application ten (10) working days after submission at CPD Division (Central Office),
telephone numbers (+632) 8810-84-15 (PRC-PICC), or email at [email protected]
CHECKLIST OF REQUIREMENTS
Supporting Documents
[ ] Instructional Design as prescribed by the relevant Board.
[ ] Program of Activities showing time/duration of topics/workshop and resource persons with position
and office, and evaluation period.
[ ] Evaluation method or tool that measures the learning gained by the participants specific and
appropriate to course objectives set
[ ] Resume of resource persons relevant to CPD program applied for.
[ ] Photo copy of valid Professional Identification Card of resource persons if registered professional.
Otherwise, submit photocopy of government-issued or company Identification Card.
[ ] Valid Special Temporary Permit if the resource person is a foreigner and if engagement is more than
three (3) days or there is physical contact with patients in the case of medical and allied professions.
[ ] Breakdown of expenses for the conduct of the CPD program.
[ ] For Online Learning, Declaration of Minimum Technical Requirements (e.g. Operating System,
Processor, Memory, Browser, Internet Connection, etc.)
Additional Requirements
[ ] Short brown envelope for the Certificate of Accreditation
[ ] One (1) set of metered documentary stamps worth Twenty-Five Pesos (₱ 25.00) each to be affixed to
the Certificate of Accreditation. (Available at PRC Customer Service and PRC Regional Offices)
[ ] Soft copy of the Application including supporting attachments in PDF format saved in flash drive.
Note:
1. Application for accreditation should be filed 15 working days before the offering of the program/training.
2. Representative/s filing application/s for accreditation and claiming the Certificate of Accreditation on
behalf of the applicant must present a letter of authorization and valid identification cards of both the
authorized signatory and the representative. In the case of national organizations with chapters/councils,
endorsement from the national board.
3. The period for processing the application is 10 working days, subject to the stipulations in these
guidelines.
4. If additional requirement/s is/are needed, a period of another 10 working days is given to submit the
same. Failure to comply within the period shall be construed as abandonment of application and the
prescribed fee shall be forfeited in favor of the government.
5. The CPD Council shall have the right to specify additional requirements if deemed necessary and
appropriate.

CPDD-02
Rev. 04
June 29, 2020
Page 2 of 2

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