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Destination: Aquiraz, Brazil
Team Leader - Dr. Manoj Abraham
next
Host: Fundamed of Fortaleza
Where team will be staying: Pousada do Sol, Rua do
Sol, s/n, Praia do Presidio, Aquiraz Ceara, 61700-000
Hospital: Hospital
Municipal de Aquiraz / Dr. Anamaria Cavalcante e Silva
Health Secretary
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Contacts at HTCNE: Missy Law
- Program Director
Office phone: 860-355-1828 ext 24 (Missy)
fax 860-350-6634
For Inquiries on information received and data entry of this website
contact: 860-355-1828 ext 23.
Administrator: Dana Buffin 860-355-1828 x 29 |
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Participants: |
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Surgery Team |
License to Practice |
CV |
Diploma |
On Line Reg.
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Health Form |
Release of Liability |
Passport Info |
credit card auth |
Evac Insur $45.00 |
Air Fare
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Travel Visa $140.00
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Manoj
Abraham, MD, Facial Plastic &ENT /
TEAM LEADER |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
cc |
money order
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Alex
Ovchinksy, MD
Facial Plastic & ENT |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
need form of payment |
money order
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Joshua
Bedwell, MD
ENT (Resident)
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in
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in
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in
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in
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in
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in
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in
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Grant or Manoj card
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cc
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cc
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money order
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Vikas
Mehta, MD
ENT (Resident) |
in |
in |
in |
in |
in |
in |
in |
Grant or Manoj card |
cc |
cc |
money order
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Anesthesia Team |
License to Practice |
CV |
Diploma |
On Line Reg.
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Health Form |
Release of Liability |
Passport Info |
credit card auth |
Evac Insur $45.00 |
Air Fare
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Travel Visa $140.00
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Nick
Schewtschenko, CRNA |
in |
in |
in |
in |
in |
in |
in |
in |
in |
in |
money order
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Mike Simon,MD
Anes Director |
in |
in |
in |
in |
in |
in |
# in / need copy via
reg mail |
in |
cc |
cc |
money order
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Marcia
Gnagey, CRNA |
in |
in |
in |
need |
need |
need |
in |
need |
need |
need |
paid |
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Robin
Birchenough, CRNA |
need |
need |
need |
need |
need |
need |
need |
need |
need |
need |
money order
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OR Techs and
Circulating RNs |
License to Practice |
CV |
Diploma |
On Line Reg.
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Health Form |
Release of Liability |
Passport Info |
credit card auth |
Evac Insur $45.00 |
Air Fare
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Travel Visa $140.00
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Chikela Cody,
CST |
cert in |
in |
in |
in |
in |
in |
in |
in |
in |
in |
money order
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Renee Melfe,
RN |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
cc |
money order
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Debbie Fritz, RN |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
cc |
money order
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Bibi
Yasin,
Cert Surg Tech |
cert in |
in |
need |
in |
in |
in |
in |
in |
need- not on auth form |
cc |
money order
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Recovery Staff
& Circulators
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License to Practice |
CV |
Diploma |
On Line Reg.
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Health Form |
Release of Liability |
Passport Info |
credit card auth |
Evac Insur $45.00 |
Air Fare
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Travel Visa $140.00
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David
Fenner, MD Pediatrician /
Medical Director |
in |
in |
in |
in |
in |
in |
in |
in |
in |
need (not on auth form) |
money order
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Kavita Aggarwal,
MD Internist |
in x06/08 |
in |
in |
need |
in |
in |
in |
in- Manoj card |
cc |
cc |
money order
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Tamara
Faublas-Joseph, RN |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
cc |
money order
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Mary Hayden, RN |
need new x01/08 |
in |
in |
in |
in |
in |
in |
in |
cc |
cc |
money order
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Elaine Suderio-Tirone, RN |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
cc |
money order
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Ann
Collazuol, RN (RR)
|
in
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need
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in
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in
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in
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in
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in
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in
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cc
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cc
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money order
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Miriam
Lynn, RN (RR)
|
in
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in
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need
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in
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in
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in
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in
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in
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cc
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cc
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money order
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Administration |
License to Practice |
CV |
Diploma |
On Line Reg.
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Health Form |
Release of Liability |
Passport Info |
credit card auth |
Evac Insur $45.00 |
Air Fare
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Travel Visa $140.00
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Dana Buffin,
Admin. |
NA |
NA |
NA |
NA |
need |
need |
in |
need |
need |
need |
already have
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Kathy
McGovern, Admin |
NA |
NA |
NA |
NA |
need |
need |
in |
need |
need |
need |
money order
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Annabel Clark,
Photographer |
NA |
NA |
NA |
NA |
in |
in |
in |
in |
cc |
HTCNE |
money order
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Kerry
Lynn, Admin in Training |
NA |
NA |
NA |
NA |
in |
in |
in |
in |
cc |
cc |
money order
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Maria Oliveira- Translator |
NA |
NA |
NA |
in |
need |
need |
need |
in |
cc |
cc |
money order |
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Olivia Birchenough |
NA |
NA |
NA |
NA |
need |
need |
need |
need |
need |
need |
money order |
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Travel Visa
Requirements:
Passport
Visa Application - completed and signed
(Any Questions call Missy or Dana at HTCNE)
One 2X2 Passport Photo
U.S. Post Office Money Order - $140.00
Payable to the Brazilian Consulate
Make sure that your passport is valid for six
months past July 2008 |
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| Flight
Information: |
Departure:
TAM Airlines
August 3 JJ8083 JFK-GRU 9:25a
8:25p
August 3 JJ3322 GRU-FOR 11:59p 3:19a
Arrives on Aug 4
August 10 JJ3301
FOR-GRU 5:15p
8:45p
August 10 JJ8080 GRU-JFK 10:30p 7:30a
Arrives Aug 11
$1,270.30 airfare & $92.78 ticketing/segment
fees =
$1,363.08
Team will split free ticket so fare will be
approx $1,320.00 pp
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Marcia Gnagey - 8/3/08 AA
Boston-Logan 6 a.m. arrive JFK 7:10 a.m. ($314)
Hotel Information: Pousada Do Sol
Please
note: If for any
reason you are
unable to travel it
is important that
you contact the Team
Leader or Admin
right away so that
your spot can be
filled. If you
get sick and are
unable to travel at
the last minute,
please also contact
the airline and
notify them that you
will not be using
your ticket.
This will allow us
to negotiate (with a
doctors note) a
replacement voucher
for a future
trip. If you
do not notify them
before the flight
leaves the ticket
will be lost.
Fax Forms to HTC at 860-350-6634
Mail Forms to HTC at P.O. Box 129, New Milford, CT 06776
E-mail to mlaw@htcne.org
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