Destination:
Santa Marta,
Colombia
Home :
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Download Trip Forms
(Print out and either e/m & scan or FAX / send those with
signature
requirement
& Passport photo
page via Mail)
IF the chart below shows
that a
CV, Medical
License, Med. School
Diploma, or
Delineation of
Privileges is needed,
please fax or email
them to the office right
away. We need
these to secure your
working permits in
country.
(860) 350 6634 - fax
Destination:
Santa Marta,
Colombia
Specialty:
Cleft
Lip and
Palate,
Exodontia,
Dental Care
Team Leader:
Dr. Matt
Goldschmidt |
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Dates:
5/3/08 to
5/10/08 |
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Sponsor:
UNIMA
Cecilia
Santos de
Cely
(speaks very
little
English)
Ximenas
(Speaks
Fluent
English)
57-315-725-9591
Hospital:
Hospital
Fernando
Troconis
University
Hospital
carrera 14
#23-42
Santa Marta,
Colombia
Director Dr.
Juan Eljuade
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Updates: |
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Site Contact
Info.:
Ximenas
011-575-422-8968
Lodging
Info:
HEADQUARTERS
VACACIONAL
"THE
TRUPILLOS"
Cra. 4 #
34-66 VIA
RODADERO
SANTA MARTA.
TELEPHONE 4
2 3 5 9 4 9
MAIL:
sedetrupillos@yahoo.es
See below
for flight
information
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Click on any
Team member
name in blue
to send an
e-mail |
Team Leader
/ Dr. Matt
Goldschmidt
/ Administrative
Contact Lisa
McNamara
Office
Contact :
Missy
860-355-1828
x24 /
Paperwork
Log in-
Georgann
860-355-1828
x23 |
e/mail entire
team |
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Participants: |
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SURGEONS: |
CV |
Lic |
Diploma |
Del. of Privleg. |
On Line Applic. |
Health/
Med
Hist |
Signed
Release
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Passport
Info |
Credit
Card
Auth |
Evac
Insur
Fee |
Air
Fare |
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Matt Goldschmidt, MD, DMD, FACS |
in |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
*See
Dr.
G. |
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Lauren D. Goldschmidt, DMD |
in |
in |
in |
NA |
in |
in |
in |
in |
see
Dr.G |
cc |
*See
Dr.
G. |
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Nicholas Diamantis, MD |
in |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
*See
Dr.
G. |
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Tim Bizga, DDS |
in |
in |
in |
NA |
in |
in |
in |
in |
in |
cc |
*See
Dr.
G. |
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ANESTHESIOLOGY: |
CV |
Lic |
Diploma |
Del. of Privleg. |
On line Reg. |
Health/
Med
Hist |
Signed
Release
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Passport
Info |
Credit
Card
Auth |
Evac
Insur
Fee |
Air
Fare |
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Steve Ditto, MD |
in |
in |
in |
in |
in |
in |
in |
in |
in |
cc |
*See
Dr.
G. |
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Lisa Mueller, CRNA |
in |
in |
in |
need |
in |
in |
in |
in |
need |
need |
*See
Dr.
G. |
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PEDIATRICS:
|
CV |
Lic |
Diploma |
Del. of Privleg. |
On line Reg.
|
Health/
Med
Hist |
Signed
Release
|
Passport
Info |
Credit
Card
Auth |
Evac
Insur
Fee |
Air
Fare |
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Arthur Lavin, MD |
in |
in |
in |
in |
NA |
in |
in |
in |
in |
cc |
*See
Dr.
G. |
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NURSING: |
CV |
Lic |
Diploma |
Del. of Privleg. |
On line Reg. |
Health/
Med
Hist |
Signed
Release
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Passport
Info |
Credit
Card
Auth |
Evac
Insur
Fee |
Air
Fare |
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Angie Hartman, RN |
need |
in |
need |
NA |
in |
in |
in |
in |
in |
cc |
*See
Dr.
G. |
Luz Gonzalez
Dental
Assist |
in |
in |
in |
NA |
in |
in |
in |
in |
in |
cc |
*See
Dr.
G. |
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Tammy Piper, RN |
in |
in |
in |
NA |
in |
in |
in |
in |
in |
cc |
*See
Dr.
G. |
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Tammy Balzer, RN |
in |
in |
in |
NA |
in |
in |
in |
in |
in |
cc |
*See
Dr.
G. |
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Administration/Ancillary |
CV |
Lic |
Diploma |
Del. of Privleg. |
On line Reg. |
Health/
Med
Hist |
Signed
Release
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Passport
Info |
Credit
Card
Auth |
Evac
Insur
Fee |
Air
Fare |
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Lisa McNamara, Admin |
NA |
NA |
NA |
NA |
in |
in |
in |
in |
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cc |
*See
Dr.
G. |
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Steven Balzer, Admin Assistant |
NA |
NA |
NA |
NA |
in |
in |
in |
in |
in |
cc |
*See
Dr.
G. |
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*
Membership
Dues have been
eliminated.
You will be charged
for your
Evacuation Insurance
policy which is
mandatory - $45.00
pp.
Dr. Goldschmidt will
be collecting your
airfare fees.
Please reach out to
Matt to settle your
airfares.
Departure:
02 May
UA 7135 CLE to
IAD
7:20 pm
8:39 pm
UA 7525 IAD to
JFK
10:05 pm
11:22 pm
overnight
03 May
AV 0021 JFK to
BOG
8:00 am
1:05 pm
AV 9768
BOG to SMR
7:30 pm
8:55 pm
Return:
09 May
AV 9767 SMR to BOG
3:20 pm
4:38 pm
AV 0020 BOG to
JFK
10:55 pm
5:30 am (10 MAY)
UA 7522 JFK to
IAD
10:17 am
11:40 am
UA 7163 IAD to
CLE
12:38 pm 1:57
pm
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.
Travel arrangements
by:
Ann Salzo
Worldtek Travel
203-773-6446
Travel
Agency Information:
In case you have
issues with your
group travel:
Ann Salzo is your
agent with WorldTek
Travel
WorldTek Travel
203-772-0470
/
After
5:30pm
it switches to ETS
(Emergency Travel
Service)
The AV # in Colombia
Toll free is:
01-8000-12-3434
And local in
Santa Marta
is:
4210276 /
4210278
/ 4210279
/ 4211276
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 |
