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PICNIC ACADEMIA

REGULAR COURSE 2017-2018

THE FOUNDATION
The Indonesian Pediatric Critical Care Foundation
(Yayasan Pediatri Gawat Darurat Indonesia)

The Indonesian Pediatric Critical Care Foundation (Yayasan Pediatri Gawat Darurat Indonesia)
is an independent non-profit organization, plays an important role in this continuing learning
journey by providing expertise and resources to complement existing pedagogy and strategic
methodologies-blended-teaching and learning module in emergency and critical care fields.
Through education and learning, The Indonesian Pediatric Critical Care Foundation (Yayasan
Pediatri Gawat Darurat Indonesia) offers a wide spectrum of programmes covering pediatric
and multidisciplinary topics in developing healthcare educations, creating the new-breed
skilled manpower, and enhancing learning processes through a suite of its expertise and
resources.

The Indonesian Pediatric Critical Care Foundation is the professional home of multi disciplines
physicians and subspecialists as well as other child health providers, including general
practitioners and nurses.

We provide continuing learning journey by expertise in tools, information and resources to


help practitioners provide the highest quality health care and new-breed skilled manpower
through existing pedagogy and strategic methodologies-blended-teaching and learning
module in emergency and critical care fields.

SIGNUP AND REGISTER OUR FREE MEMBERSHIP TODAY WITH A DIRECT INVOLVEMENT
IN OUR INNOVATION LEARNING JOURNEY AND UPDATES VIA http://www.picunicu.org/

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REGULAR COURSE 2017-2018

MANAGEMENT COMMITTEE
To achieve learning excellence, The Indonesian Pediatric Critical Care Foundation (Yayasan Pediatri Gawat Darurat
Indonesia) resources and expertises are set to make comprehensive range of educational needs

FOUNDER

Abdul Latief
Antonius H. Pudjiadi
Dadang Hudaya Somasetia
Darlan Darwis
Dzulfikar Djalil Lukmanul Hakim
H. Munar Lubis
Novik Budi Wardhana
Silvia Triratna
Susetyo Harry Purwanto

CO-CHAIR PRESIDENT MEMBERS

Yani Akhyar Kasim Abdul Latief Chairul Yoel


Darlan Darwis Dzulfikar Djalil Lukmanul Hakim
H. Munar Lubis Novik Budi Wardhana
Ririe Fachrina Malisie
TRUSTEE VICE-PRESIDENT Irene Yuniar
Rismala Dewi
Susetyo Harry Purwanto Antonius H. Pudjiadi Nurnaningsih
Dadang Hudaya Somasetia Rinawati Rohsiswatmo
Silvia Triratna Risma Kerina Kaban
TREASURER Lily Rundjan
Rosalina Dewi Roeslani
Eva Miranda Marwali

STRATEGIC TEAM

Abdul Latief Rinawati Rohsiswatmo


Antonius H. Pudjiadi Lily Rundjan
Ririe Fachrina Malisie

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REGULAR COURSE 2017-2018

WHAT WE DO
VISION

Partnering and supporting the Pediatric Critical Care Working Group of Indonesian Pediatric Society,
Hospitals, Associations, Healthcare Institutions, Corporations and Government Agencies, both at
national and international level, The Indonesian Pediatric Critical Care Foundation (Yayasan Pediatri
Gawat Darurat Indonesia) has a strong pursuit and networks that provides a vibrant and conductive
environment to empower healthcare professionals with expertise and resources needed to advance
clinical knowledge and expertise in the effort of providing high quality patient care at frontiers of medicine.

MISSION

The mission is accomplished by promoting the professional growth and development of its diverse
membership, representing general health professionals in pediatric emergency medicine and critical
care, child health research, pediatric medical educations and related disciplines.

JOIN OUR PROGRAM

PRO COMMUNITY

Pro Community is a forum platform of scientific publication reviews for medical professionals in
multidisciplinary nature to exchange ideas and having brief communication in variety topics to enhance
the outlook of recent development in the field of critical care and emergency medicine. All students
undergoing medical research and/or training are also welcomed. Get the privilege involvement in the
forum for being our member through website.

PICNIC ACADEMIA

The Indonesian Pediatric Critical Care Foundation (Yayasan Pediatri Gawat Darurat Indonesia) is well
poised to provide quality healthcare education and learning to nurture from physicians primarily
pediatricians and its subspecialties; professionals across the healthcare disciplines; doctors, nurses
to allied healthcare professionals, with a holistic set of skills essential for professional development
and growth through the benefit of curriculum, teaching methodologies and learning efficiencies, both
on-line (webinars and mini courses) in E-Learnovation basis and off-line (Scientific Events and Regular
Courses).

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PICNIC ACADEMIA

REGULAR COURSE 2017-2018

REGULAR COURSE 2017-2018


The Regular Course is the entry-level healthcare educational programme developed by Strategic Team to creating
the new-breed skilled manpower, and enhancing learning processes through a suite of its expertise and resources.

It is a reserve training program with the curriculum divided in individual topics, which contain the minimum required
foundational knowledge for given subjects with stimulating hands-on for skillful requirement.

Regular Course Period 2017-2018 with new comer curriculums are set as an entry level to participate in
the Symposium Workshops of 10th Indonesian PICU NICU Update 20-26 March 2018 at The Stones Hotel
Legian Bali.

Participants, who joined the Regular Course Period 2017-2018 will be prioritized to participate the
Symposium Workshops of 10th Indonesian PICU NICU Update 20 26 March 2018

AGENDA

SWISS-BELHOTEL MALEOSAN - MANADO

FRIDAY, 14 JULY 2017 SATURDAY, 15 JULY 2017

Basic Mechanical Ventilation in Critically ill Children Basic Mechanical Ventilation in Critically ill Children
- Day 1 - Day 2

ARYADUTA HOTEL PALEMBANG

SATURDAY, SUNDAY,
15 SEPTEMBER 2017 16 SEPTEMBER 2017 17 SEPTEMBER 2017

Difficult Airway in Critically ill Basic Mechanical Ventilation in Basic Mechanical Ventilation in
Children Critically ill Children - Day 1 Critically ill Children - Day 2

GRAND SWISS-BELHOTEL, MEDAN

SATURDAY, 28 OCTOBER 2017 SUNDAY, 29 OCTOBER 2017

Basic Mechanical Ventilation in Critically ill Children Basic Mechanical Ventilation in Critically ill Children
- Day 1 - Day 2

GRAND JATRA HOTEL, BALIKPAPAN

SATURDAY, 18 NOVEMBER 2017 SUNDAY, 19 NOVEMBER 2017

Basic Mechanical Ventilation in Critically ill Children Basic Mechanical Ventilation in Critically ill Children
- Day 1 - Day 2

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REGULAR COURSE 2017-2018

WISMA 76, SLIPI - JAKARTA

SATURDAY, SUNDAY,
08 DECEMBER 2017 09 DECEMBER 2017 10 DECEMBER 2017

Difficult Airway in Critically ill Basic Mechanical Ventilation in Basic Mechanical Ventilation in
Children Critically ill Children - Day 1 Critically ill Children - Day 2

SANTIKA PREMIERE HOTEL BINTARO, TANGERANG

FRIDAY, 23 FEBRUARY 2018 SATURDAY, 24 FEBRUARY 2018 SUNDAY, 25 FEBRUARY 2018

Difficult Airway in Critically ill Basic Mechanical Ventilation in Basic Mechanical Ventilation in
Children Critically ill Children - Day 1 Critically ill Children - Day 2
Post Resuscitation Stabilization Post Resuscitation Stabilization
Management- Day 1 Management - Day 2
Comprehensive Pediatric Sepsis Comprehensive Pediatric Sepsis
Management Day 1 Management Day 2
Basic Non-Invasive Ventilation Basic Mechanical Ventilation in Basic Mechanical Ventilation in
in Newborn Infants Newborn Infants Newborn Infants: Clinical Practice

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PICNIC ACADEMIA

REGULAR COURSE 2017-2018

BASIC MECHANICAL VENTILATION


IN CRITICALLY ILL CHILDREN WORKSHOP
INTRODUCTION
To learn the indications; physiology; respiratory mechanism; and principal of mechanical ventilation in critically ill pediatrics, learn
about initial parameters; how to choose initial settings & adjustment as well as monitoring and weaning of mechanical ventilator
support in sick children

TERM & CONDITION


Basic Mechanical Ventilation in Pediatric Workshop is a compulsory entry level to join Advanced Modes on Mechanical Ventilation
in Children Workshop, which held as the Symposium Workshop of 10th Indonesian PICU NICU Update.

DATE
Two Days Program *See above detail Agenda

PLACE
*See above detail Agenda

COURSE DIRECTOR
Dr. Ririe F. Malisie, dr, SpA(K)

PROGRAM

DAY 1 TOPIC
Opening Remark
08.15-08.45 Pre-Test
08.45-09.45 Basic Principles of Mechanical Ventilation in Children
09.45-10.00 Coffee Break
10.00-11.00 Ventilator Modes and Wave-Forms
11.00-11.45 Initial Setting and Adjusting of Mechanical Ventilation
11.45-12.00 Discussion
12.00-13.00 Lunch and Pray Time
13.00-16.00 SKILL STATIONS (1 hour rotated)
O2 and CO2 Problems
Interpretation of Wave-Forms
Initial Setting and Adjusting

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DAY 2 TOPIC
Non-Invasive Ventilation in Critically ill Children
08.45-09.30 Monitoring of Children on Ventilatory Support
09.30-10.15 Weaning Strategies
10.15-10.30 Coffee Break
10.30-12.30 HANDS ON CASES SIMULATION (60 Rotated)
Hypoxic Respiratory Failure (Severe Pneumonia)
Hypercapnic Respiratory Failure (Asthma)
Patient with Guillian Barre Syndrome
12.30-13.30 Lunch and Pray Time
13.30-14.30 HANDS ON CASES SIMULATION (Continued )
Hypoxic Respiratory Failure (Severe Pneumonia)
Hypercapnic Respiratory Failure (Asthma)
Patient with Guillian Barre Syndrome
14.30-15.00 Post-Test
15.00-15.40 Evaluation & Course Wrap
15.40-16.00 Coffee Break

INSTRUCTOR TEAM
Abdul Latief (Jakarta)
Antonius Pudjiadi (Jakarta)
Ririe Fachrina Malisie (Medan)
Sri Martuti (Solo)
G. Dharma Mulyo (Jakarta)
Yusrina Istanti (Semarang)
Saptadi Yuliarto (Malang)

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DIFFICULT AIRWAY IN CRITICALLY ILL CHILDREN


INTRODUCTION
The Pediatric Airway Skills Course equips learners with the tools necessary to manage a difficult pediatric airway in critically ill
children. The course will review patient positioning, techniques for improved airway visualization, as well as review skills and
tools that can make a difference in the challenging airway patient. Learners will be exposed to laryngoscopic intubation, laryngeal
mask airways, bougies, GlideScopes, transtracheal jet ventilation as well as Seldinger and McIntyre cricothyroidotomies.

During the hands-on phase, learners will receive direct instruction and practice using this equipment. The learners will then apply
their new knowledge by being placed into a high-fidelity simulation experience where they will be challenged to use these new
techniques.

This workshop is for trainees and consultants who wish to refresh and update skills in managing children in critically ill with a
difficult airway. The course aims to discuss the management of the anticipated and unanticipated paediatric difficult airway. The
format of the day is one of short interactive lectures, videos and hands-on small group workshops. The workshops cover care
and basic use of the fibre-optic laryngoscope, modified airway and LMA access techniques using guidewires and exchange
catheters.

DATE
One Day Program *See above detail Agenda

PLACE
*See above detail Agenda

COURSE DIRECTOR: Dr. dr. Ririe Fachrina Malisie, SpA(K)


CO-COURSE DIRECTOR Dr. dr. Dzulfikar DLH, SpA (K), Mkes MMRS

PROGRAM

TIME TOPIC FACILITATOR


08.00 - 08.30 Registration

08.30 - 09.00 Pre-Test Ririe F Malisie


09.00 - 09.45 Introduction of Difficult Airway Management in Critically ill Children Abdul Latief
09.45 - 10.30 Recognition of Stridor and Difficult Airway in Pediatric Dzulfikar DLH
10.30 - 11.30 Techniques and Galleries of Tools in Pediatric Difficult Airways Andi Ade Wijaya
11.30 - 12.00 Algorithm of Pediatric Difficult Airway Ririe F Malisie
12.00 - 13.00 Lunch & Pray

Skill Station: DRY WORKSHOP

13.00-16.00 The Devices to Maintain Open Airway in Critically ill Children Ririe F Malisie
Basic Airway Management & the Use of Video Laryngoscope Andi Ade Wijaya

Emergency Airway Management and Needle Cricothyroidotomy Dzulfikar DLH

16.00 - 16.30 Post-Test Ririe F Malisie


16.30 - 16.45 Evaluation & Wrap Abdul Latief
16.45 - 17.00 Coffee/Tea Break

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POST RESUSCITATION - STABILIZATION MANAGEMENT


INTRODUCTION
Post-resuscitation care is a critical component of advanced life support. Patient mortality remains high after return of
spontaneous circulation and initial stabilization. Include the post-resuscitation care are: optimize hemodynamic, respiratory,
and neurologic support; identify and treat reversible causes of arrest; and monitor temperature and consider treatment for
disturbances of temperature regulation and metabolism. When spontaneous circulation is restored after cardiopulmonary
arrest in critically ill children, these are the goals of treatment:
Avoid cardiopulmonary arrest recurrance
Restore perfusion and oxygenation
Evaluate and monitor neurologic functions
Support dysfunctioning organs
Resolve the situation that promoted cardiopulmonary arrest
Multi organ failure secondary to hypoxic ischemic insult requires partial or complete support of each organ function.
Strategies to keep systemic perfusion and oxygenation adequate are the rule. Maintaining and protecting neurologic
function is essential for a good outcome.

DATE
Two Days Program on 24 25 February 2018

PLACE
Hotel Santika Premiere Bintaro Tangerang Selatan

COURSE DIRECTOR & CO:


Dr. dr. Dzulfikar DLH, SpA(K) M.Kes MMRS & Dr. dr. Ririe Fachrina Malisie, Sp.A(K)

PROGRAM

DAY 1 SATURDAY, 24 FEBRUARY 2018 FACILITATOR


08.00-08.15 Opening Remarks Dzulfikar DLH
08.15-08.45 Pre-Test Ririe F Malisie
08.45-09.15 Mechanical Ventilation: Initial Setting and Adjusting Saptadi Yuliarto
09.15-09.45 Sedation & Analgesia Dzulfikar DLH
09.45-10.00 Coffee break
10.00-10.30 Management of Increased Intracranial Pressure Rismala Dewi
10.30-11.00 Hypo and Hyperglycemia Yusrina Istanti
11.00-12.00 SKILL SESSION
Divided to Mechanical Ventilation: Initial Setting and Adjusting Saptadi Yuliarto
4 Groups Sedation & Analgesia Dzulfikar DLH
Rotate
@60min Management of Increased Intracranial Pressure Rismala Dewi
Hypo and Hyperglycemia Yusrina Istanti
12.00-13.00 ISHOMA
13.00-16.00 SKILL SESSIONcontinued
Divided to Mechanical Ventilation: Initial Setting and Adjusting Saptadi Yuliarto
4 Groups Sedation & Analgesia Dzulfikar DLH
Rotate
@60min Management of Increased Intracranial Pressure Rismala Dewi
Hypo and Hyperglycemia Yusrina Istanti

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DAY 2 SUNDAY, 25 FEBRUARY 2018 FACILITATOR


08.00-08.30 Hemodynamic Assessment & Management Irene Yuniar
08.30-09.00 Fluid and Electrolytes Management Dzulfikar DLH
09.00-09.15 Coffee Break
09.15-09.45 Disseminated Intravascular Coagulation Saptadi Yuliarto
09.45-10.15 Management of Systemic Infection Rismala Dewi
10.15-12.15 SKILL SESSION
Divided to Hemodynamic Assessment & Management Irene Yuniar
4 Groups Fluid and Electrolytes Management Dzulfikar DLH
Rotate
@60min Disseminated Intravascular Coagulation Saptadi Yuliarto
Management of Systemic Infection Rismala Dewi
12.15-13.00 ISHOMA
13.00-16.00 SKILL SESSION (continued)
Divided to Hemodynamic Assessment & Management Irene Yuniar
4 Groups Fluid and Electrolytes Management Dzulfikar DLH
Rotate
@45min Disseminated Intravascular Coagulation Saptadi Yuliarto
Management of Systemic Infection Rismala Dewi
16.00-16.30 Post-Test Ririe F Malisie
16.30-16.45 Evaluation & Course Wrap Dzulfikar DLH
16.45-17.00 Coffee Break

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REGULAR COURSE 2017-2018

COMPREHENSIVE PEDIATRIC SEPSIS MANAGEMENT


INTRODUCTION
To enhance the updated knowledge and practical guidelines in the comprehensive management of sepsis in children
included the understanding sepsis pathophysiology in children, the International standard for pediatrics sepsis & Surviving
Sepsis Campaign as well as the Early Goals Directed Therapy for pediatric sepsis implementations upon the latest
guidelines.

DATE
Two Days Program on 24 25 February 2018

PLACE
Hotel Santika Premiere Bintaro Tangerang Selatan

COURSE DIRECTOR & CO:


Abdul Latief, dr, SpA(K)

PROGRAM

DAY 1 SATURDAY, 24 FEBRUARY 2018 FACILITATOR


08.00 - 08.15 Introduction
08.15 - 08.45 Pre-Test Abdul Latief (Jakarta)
08.45 - 09.30 Overview of Indonesian Pediatric Sepsis Consensus Abdul Latief (Jakarta)
09.30 - 10.15 Surviving Sepsis Campaign Dadang Hudaya (Bandung)
10.15 - 10.30 Discussion
10.30 - 11.10 Coffee break
GROUP DISCUSSION
[Participants are divided into 4 Groups @ 50 minutes
Rotation]
11.10 - 12.00 Hemodynamic Support Strategy Irene Yuniar (Jakarta)
12.00 - 13.00 Lunch
13.00 - 13.50 Fighting Infections Rahma Mulya Karyanti (Jakarta)
13.50 - 14.40 Protective Ventilation Strategy M Supriatna (Semarang)
14.40 - 15.30 Glucose Control Nurnaningsih (Jogjakarta)
15.30 - 16.10 Coffee Break

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DAY 2 SUNDAY, 25 FEBRUARY 2018 FACILITATOR


GROUP DISCUSSION
[Participants are divided into 4 Groups @ 50 minutes
Rotation]
08.00 - 08.50 Sedative and Analgesic Dadang Hudaya (Bandung)
08.50 - 09.40 Coagulation Problems M Supriatna (Semarang)
09.40 - 10.00 Coffee Break
10.00 - 10.50 Pediatric Logistic Organ Dysfunction Score Abdul Latief (Jakarta)
10.50 - 11.40 Nutritional Support Nurnaningsih (Jogjakarta)
11.40 - 13.00 Lunch
13.30 - 14.30 Post Test Abdul Latief (Jakarta)
14.30 - 15.00 Course Wrap & Evaluation Abdul Latief (Jakarta)
15.00 - 15.30 Coffee Break

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BASIC NON-INVASIVE VENTILATION


IN NEWBORN INFANTS

DATE
One Day Program on Friday, 23 February 2018

PLACE
Hotel Santika Premiere Bintaro Tangerang Selatan

COURSE DIRECTOR
Risma K. Kaban, dr, SpA(K) - (Jakarta)

PROGRAM

DAY 1 FRIDAY, 23 FEBRUARY 2018 INSTRUCTOR


08.00 - 08.15 Opening
08.15 - 08.35 Basic Principles of Non Invasive Ventilation Rinawati Rohsiswatmo
08.35 - 08.55 CPAP Rosalina Roeslani
08.55 - 09.15 High Flow and Low Flow Nasal Cannulae Rosalina Roeslani
09.15 - 09.30 Discussion
09.30 - 09.50 Coffee break
09.50 - 10.20 SiPAP: Complete Mode Rinawati Rohsiswatmo
10.20 - 10.50 Nursing Care of Non Invasive Ventilation Ns. Dian Anggur
10.50 - 11.20 Nasal IMV Adhi TP
11.20 - 11.50 Nasal HFO : New Modality Putri Maharani
13.20 - 15.35 SKILL STATION
Divided in to 3 groups @ 45 Minutes
CPAP (Buble, Ventilator), High Flow and Low Flow Putri Maharani/Ns. Dian Anggur
Nasal IMV Adhi TP
SiPAP and Nasal HFO Rinawati Rohsiswatmo
15.35 - 16.00 Coffee Break
16.00 - 16.30 Summary

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BASIC MECHANICAL VENTILATION


IN NEWBORN INFANTS

DATE
One Day Program on Saturday, 24 February 2018

PLACE
Hotel Santika Premiere Bintaro Tangerang Selatan

COURSE DIRECTOR
Dr. Rinawati Rohsiswatmo, dr, SpA(K) - (Jakarta)

PROGRAM

DAY 2 SATURDAY, 24 FEBRUARY 2018 INSTRUCTOR


08.00 - 08.15 Opening
08.15 - 08.45 Basic Principles of Mechanical Ventilation Adhi TP
08.45 - 09.15 Initial Setting and Adjusting Rinawati Rohsiwatmo
09.15 - 09.45 Ventilator Modes and Wave Forms Adhi TP
09.45 - 10.15 Coffee Break
10.15 - 11.00 Volume Guarantee Adhi TP
11.00 - 11.30 Weaning Strategies Rinawati Rohsiwatmo
11.30 - 12.00 Blood Gas Analysis Rosalina Roeslani
12.00 - 13.00 Lunch
13.00 - 13.30 Nursing Care of Ventilated Babies and Troubleshooting Ns. Selly Ramadhani
13.30 - 15.45 SKILL STATION
Divided in to 3 groups @ 45 Minutes
Volume Guarantee Rosalina Roeslani
Interpretation of Wave Forms Adhi TP
Initial Setting and Adjusting Rinawati Rohsiswatmo
15.45 - 16.10 Coffee Break
16.10 - 16.30 Summary

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BASIC MECHANICAL VENTILATION


IN NEWBORN INFANTS: CLINICAL PRACTICE

DATE
One Day Program on Sunday, 25 February 2018

PLACE
Hotel Santika Premiere Bintaro Tangerang Selatan

COURSE DIRECTOR
Dr. Rinawati Rohsiswatmo, dr, SpA(K) - (Jakarta)

PROGRAM

DAY 3 SUNDAY, 25 FEBRUARY 2018 INSTRUCTOR


08.00 - 08.15 Opening
08.15 - 08.45 Ventilation Management in RDS Babies Adhi TP
09.15 - 09.45 Management of MAS Rosalina Roeslani
09.15 - 09.45 Management of PPHN Putri Maharani
09.45 - 10.30 Coffee break
10.30 - 11.00 Principle of HFOV Rinawati Rohsiwatmo
11.00 - 11.30 HFOV in Specific Diseases : CDH, Hidrops, etc Rinawati Rohsiwatmo
11.30 - 12.00 Extensive Use of Surfactant Therapy Adhi TP
12.00 - 13.00 Lunch
CASE STUDIES
Divided into 2 groups (@ 60 mins)
13.00 - 14.00 Case Studies Conventional MV Adhi TP/Rosalina Roeslani
14.00 - 15.00 Case Studies HFOV Putri Maharani/Rinawati
Rohsiswatmo
15.00 - 15.30 Summary and Wrap Up

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REGISTRATION & ACCOMMODATION


HOW TO REGISTER
1. Fax the Registration Form to +6221. 29315471 or Email to secretariat@picunicu.org along with proof of
payment (e.g. copy of bank transfer slip).
2. Payment Proof is strongly recommended to be done along with your Registration Form submission.
Photocopied forms are acceptable.
3. You may bring your payment proof as foreseen at the Re-Registration counter. Essentially, the name tag
issued is an initial confirmation of registrants.

REGISTRATION CONFIRMATION
Participants are strongly suggested to make Re-Confirmation due to incoming facsimiles/Email and/or payment
made to our Registration Department, hotline numbers at office hours.

Confirmation Hotline: 021. 29315470 / 0811882080 / 0819882080

WHO SHOULD ATTEND


Specialists and Health Practitioners-whose interested in Pediatric and Neonates Intensive and Critical Care,
such as Specialists Neonates Intensivist Pediatric Intensivist; Respiralogy; Hematology; Infectious Diseases;
Neurology; Nutrition & Metabolism; Gastroenterology; Immunology; Cardiology Pediatric Surgery Pediatric
Anesthesiologists Trainee Emergency Doctors General Practitioners

CERTIFICATION
Accredited by IDI & CPD IDAI

COURSE CAPACITY
Limited to 60 participants/batch

REGISTRATION INFO
Registration per batch will be closed 2 weeks before workshop held. No On-Site.
Registration Form could be obtained via Secretariat Ex-Officio contact numbers or email to secretariat@
picunicu.org
Allocation per batch would be made upon first come first payments. Secretariat Ex-Officio reserves the
rights to accommodate the participants to the next batch due to the full-seats
Registration confirmation is a must after registration payments. Secretariat Ex-Officio reserves the right not
to guarantee any seats for any unconfirmed registrations in the workshop held.
Registration payment proof (copy is eligible) must be shown when re-register
Re-Registration service will be handed out since 07.00 morning on the first day of workshop at the venue
Certificate will be handed out to the participants at the end of the workshop with the pre and post-test
requirements

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CANCELLATION POLICY
REGISTRATION
Any cancellation or replacement must be conveyed to the Secretariat Ex-Officio in written at the latest
7 (seven) days prior the workshop dates without charge and changeable for substitution name and/or
next batch allocation.
An administrative fee 20% of the registration fee will be charged for cancellation 7 (seven) days prior
the workshop held and still changeable for substitution name and/or next batch allocation.
Any replacement/substitution name on the workshop dates will be preceded as a new chargeable
registration.
No show on workshop dates would be considered as cancellation without refund.

ACCOMMODATION
Hotel room rate is net for room only.
Please note that official check-in time is 14.00 local time and check-out time is 12.00 local time. Approval
of early check-in and late check-out is at discretion of the hotel.
No reservation will be made without full deposit of nights booking due to room availability.
Any changes and cancellations regarding to room reservation in pre-registration period must be done
in writing to the Secretariat at least 168 hours prior to arrival. After the date, guaranteed payment for 1
night will be charged.
No Show will be applied on the first night for delayed or postpone staying that causes the loss of 1 night
room deposit made.
In the event of materialization, the hotel will charge the full amount duration of stay upon check-out that
causes the loss of mentioned deposit made.
Refund may only be made after the event by bank transfer. Official letter should be submitted to
Secretariat address mentioning its payers Bank Account.

RE-REGISTRATION SERVICE
The Re-Registration will be handed out to the participants from registration counters during the opening hours
at 07.00 09.00 on the first day of the course schedule

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Notes
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REGISTRATION & ACCOMMODATION FORM


T (Kindly completed)
PARTICIPANT
Full Name & Title : _________________________________________________________________________________________

Institution : _________________________________________________________________________________________

Home Address : _________________________________________________________________________________________

City / Post Code : _________________________________________________________________________________________

Phone (Mobile) : ____________________________________ Fax: _______________________________________________


_

Email : _________________________________________________________________________________________

SPONSOR (Kindly completed if any)


Full Name & Position : _________________________________________________________________________________________

Company / City : _________________________________________________________________________________________

Phone (Mobile) : ____________________________________ Fax: _____________________________________________


_

Email : _________________________________________________________________________________________

REGISTRATION (kindly appropriate box)


PERIOD REGULER COURSE NAME FIELD IDR
Fri-Sat, 14 15 July 2017
Basic Mechanical Ventilation in Critically ill Children PICU 3.000.000
Manado
Fri, 15 September 2017
Difficult Airway in Critically ill Children PICU 2.000.000
Palembang
Sat-Sun, 1617 September 2017
Basic Mechanical Ventilation in Critically ill Children PICU 3.000.000
Palembang
Sat-Sun, 28 29 October 2017
Basic Mechanical Ventilation in Critically ill Children PICU 3.000.000
Medan
Sat-Sun, 18 19 November 2017
Basic Mechanical Ventilation in Critically ill Children PICU 3.000.000
Balikpapan
Fri, 08 December 2017
Difficult Airway in Critically ill Children PICU 2.000.000
Jakarta
Sat-Sun, 0910 December 2017
Basic Mechanical Ventilation in Critically ill Children PICU 3.000.000
Jakarta
Fri, 23 February 2018
Difficult Airway in Critically ill Children PICU 2.000.000
Tangerang
Sat-Sun, 2425 Februari 2018
Basic Mechanical Ventilation in Critically ill Children PICU 3.000.000
Tangerang
Sat-Sun, 2425 Februari 2018
Post Resuscitation - Stabilization Management PICU 2.500.000
Tangerang
Sat-Sun, 2425 Februari 2018
Comprehensive Pediatric Sepsis Management PICU 2.500.000
Tangerang
Fri, 23 February 2018
Basic NIV in Newborn Infants NICU 2.000.000
Tangerang
Sat, 24 February 2018
Basic Mechanical Ventilation in Newborn Infants NICU 2.000.000
Tangerang
Sun, 25 February 2018
Basic Mechanical Ventilation in Newborn Infants: Clinical Practice NICU 2.000.000
Tangerang
g g
*10% discount for Indonesian Pediatric Critical Care Foundations Member

PAYMENT BY (Kindly appropriate circle) SEKRETARIAT


The Indonesian Pediatric Critical Care Foundation
NAYA Kemang Selatan Kav. 15
Nama Bank : CIMB Niaga
Jl. Madrasah Raya No 11 G-H, Kemang Ampera,
No. Rekening : 8000 4815 9300
Jakarta Selatan, 12560 INDONESIA
Cabang : Kebon Sirih Jakarta
Website: http://www.picunicu.org
Atas Nama : GEO convex
Email: secretariat@picunicu.org
Mobile : +62 811 88 2080 . +62 819 88 2080
Tlp : +62 21 293 15 470 (Hunting)
Fax : +62 21 293 15 471

19
PICNIC ACADEMIA

REGULAR COURSE 2017-2018

REGISTRATION & ACCOMMODATION FORM


T (Kindly completed)
PARTICIPANT
Full Name & Title : _________________________________________________________________________________________

Institution : _________________________________________________________________________________________

Home Address : _________________________________________________________________________________________

City / Post Code : _________________________________________________________________________________________

Phone (Mobile) : ____________________________________ Fax: _______________________________________________


_

Email : _________________________________________________________________________________________

SPONSOR (Kindly completed if any)


Full Name & Position : _________________________________________________________________________________________

Company / City : _________________________________________________________________________________________

Phone (Mobile) : ____________________________________ Fax: _____________________________________________


_

Email : _________________________________________________________________________________________

ACCOMMODATION
HOTEL NAME IDR

Swiss-Belhotel Maleosan Manado 650.000,- net/night

Aryaduta Hotel Palembang 700.000,- net/night

Grand Swiss-Belhotel - Medan 825.000,- net/night

Grand Jatra Hotel - Balikpapan 825.000,- net/night

Santika Premiere Hotel Bintaro - Tangerang 700.000,- net/night

Check In Date: Check Out Date:

Total Night(s):

Total Accommodation Payment: IDR

PAYMENT BY (Kindly appropriate circle) SEKRETARIAT


The Indonesian Pediatric Critical Care Foundation
NAYA Kemang Selatan Kav. 15
Nama Bank : CIMB Niaga
Jl. Madrasah Raya No 11 G-H, Kemang Ampera,
No. Rekening : 8000 4815 9300
Jakarta Selatan, 12560 INDONESIA
Cabang : Kebon Sirih Jakarta
Website: http://www.picunicu.org
Atas Nama : GEO convex
Email: secretariat@picunicu.org
Mobile : +62 811 88 2080 . +62 819 88 2080
Tlp : +62 21 293 15 470 (Hunting)
Fax : +62 21 293 15 471

20

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