indiana regional medical center, amendment request to ...july 5, 2005 regional medical center...
TRANSCRIPT
July 5, 2005
R E G I O N A L M E D I C A L C E N T E R
U.S.N.R.C. Region I 475 Allendale Road
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King of Prussia, PA 19406-1415 4 4 7
RE: License #37-13666-01 oT@O'' ~
To Whom It May Concern:
We would like to add Mr. Gregory A. Hay, as an authorized medical physicist on our materials license as per 10 CFR 35.961. Please find enclosed documentation of Mr. Hay's qualifications and proof of continuing education with regard to therapeutic radiological physics.
Thank you for your attention in this matter.
Sincerely,
Ste P4? hen A. President and CEO
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- - 8 3 5 HOSPITAL R O A D * P.O. BOX 7 8 8 * I N D I A N A . PA 1 5 7 0 1 - 0 7 8 8
TEL ( 7 2 4 ) 3 5 7 - 7 0 0 0 * FAX ( 7 2 4 ) 3 5 7 - 7 4 4 9 * w\l 'L%'INDIANARMC O R G
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fOT Education of Health pmfesbionals, hc. I
Somerset Council
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Certificate of CompIeti n 1 .
c. s .I, Radiology & Patholo& I
April 26,2005
TOTAL ASRT HOURS: 3-00
fhis 3 to ce- that the above named bdi~idual wmpletad medical education pgram.
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From:
AIlegheny General Hospital
Certificate of Attendance
This is to certlfy that I Greg Hay
Has Partkipat& in: I Radiation Oncology Network Pradcurrfi
Alkgheny Genoraf Honplhl November 4 2002
This conference Is accredited for the following:
AMA Category I Marimurn Hmurs Nvmher of Haws Attended
4.00 hours 4.00 haurs
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CertiFcate of Attendance I
registered and was in ASTRO's 43" Annual
Issued Date: 03/12/02 Kathy Tho S&ces
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Certificate of Attendance
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ALLEGHENY GENEFUL HO
Certificate of Attei This is to certify that
Gregory Hay
Has Participated in:
Radlatlon Oncology Network Practi Altegheny General Hospital
March 7,2005
This cankrence is accredited for the folioking: I
SPITAL
rdance
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AMA Category 1: Maximum HQWS Number of Hours Attended
5.00 hours 5.00 hours
Allwheny Gsnersl Hospital is acaedlied by the Acaedltation Council for Continuing I cdlceil € d u d e n to spondPr confhuing medical educetlon far phystelsns. Allegheny General Hoaphi designates $Is cuntinulng rnedlcal educ~boo actlvlty for a maxtmurn of5-m CradB houo in Category 1 of tho Physician's Recagnnion Awed of the American Medlcal Aseociation. Each phyalcren should cluirn only t h ~ ~ houm of credft'th6i h e h h e scrually spent In the eduationai activity.
1 cerQ vat f partlcipakj ITthe above CME activity for C 5 hour(s). I \ h
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SWEDISH I
I Swedish Medlcal Center and Seattle Procfate Insmute
Swedlsh Medical Center certifies t at
Gregory A. Hay, M.S. Name of Participant L.2
Has participated In the educational actfvlty/ Wed
ULTRASOUNDGUIDED TWSPERINEAL BRACHYTHERAPY FOR EARLY STAG^ PROSTATE
CANCER I AI the Sorrento Hotel, Seattle. Washington
On June 940,3003
The actlvlty was designated for 11.0 AMA PRA Category 1 credits.
1 1 C 6. Its verified by participant
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bfrscbr. Medical Education Swedlsh C M E
w m Maureen o Trlgg Eduoaticn Caordna&
Seattle Prostate lnslfhrte
- . *-_. - --- . .......... - . - . Continiihg Medicel Educndon - Swcdinh Mcdicirl CcnteT - Schttlc, Wahinp
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ALLEGHENY GENERAL HOSPIT,$L
Certificate of Attendance
This is to certlfy that
Greg Hay
Has Particfpated in:
Radiation Oncology Network Practicr Monday, November 10,2003 Mag ove rn Con f e re n ce Ce nte r
and may d a h up to a maximum of 5 crec
AMA Category I Maximum 1
Allegheny General Hospital is accredned by the Aecredltatlon CouncH far Cor Mucatinn to sponsor continuing medical education for phy6ldans. Aflegheny designates this continuing medical education a d v S for credit hours in categ PhysiDian'S Recognition Awerd of the Amarkan Medical Assoclsffon.
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Chairman Contlnuing M e w Educatlan Cornrntttee
',-- I ,cW that I pytiupabd In the above CME activity for 3 hour -
m
t hours
hours
tnulng Medical Senerial Hospital @ 1 of the
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From: 07/01/2005 09: 15 #882 P .005/'015
09
March 30,2004
h g %Y, M S Canemaugh Cancer Cam Center 1086 RmkIin street lohnstewn, PA 15905
C d f i C S that
Greg Hay, M S participated m t he educational activity entitled
Badlolmmnnothexapy in Noa-HodgMm's Lymphoma: Nuei Medicine Primer
Johns to~~ , PA
Heidi Chandonnet Director Institutu for Continuing Healthcare Education
-441 5.2004 Date Issued
I
210 Wcsr Washington S q w , PhilsdclphfP, PA 19106 Tel: 215-592-P207. ext 1420 - www.icb.edu
Certificate o f Completi d n Gregory Hay, MS RRT 1
IMRT and Oncological Emerge cies
November 16,2004
This is to cUCify ;hat thc above named individual completed medical tducation pro6plun.
I
C O W E DIRECTORS
i S r S Z Z F Z Z T t SYJ LT:TT c O O Z , ' T O / L O
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THE WESTERN PENNSYLVANIA HOSPITAL
Far
C O m U T N G 1vIEDICAL EDUCATION AC'MVITY
Treating Prostate Cancer with Image Guided LMRT and Brachytherapy
Cuune Diraclom: Jndilh H. W p n , Mn Daniel C. hvord, MS
The Western Pen-nsylvania Haspita1 is accredited by the A d i t a t i a n Council fw Continuing Medica! Education {ACCW! to spomr continuing medical dducation for physiciaus.
Pae W a k m Penrisylvania Hospital designates this ducational activiiy for up tu 2 c d t houra in Cakgw 1 4it townrdr the AMI\ Physician'$ Rmgnition Award. Each physician shouldclaim unly those houra of credit that hdsh actually Bpent in the educetianal activity.
This program w s planned in accordance wich the Awmdita~i~i~ii Council fw Continuing Medical Education (AC-7 requirements on disclosun infmtim abut rcla~ioosl.lips of pramten wich c o m i a l interest (if any>. Disclosure lnformdon W~LP inclodtd in the malerids t l i s t i i i ~ e d a the time of the conference,
Henlthcm professionah, othw than physiciaos socking ANlA Category 1 credits, may p-4 this "Certificate of Atwndance'' Lo their professions mcieties to apply for conhuing educationonits, UB applicable.
This is to ac_knowledge the receipt of your letter/application dated
7'rhr , and to inform you that the initial processing which includes an administrative review has been performed
-4 37- i3&6-0/ d There were no administrative omissions. Your application was assigned to a technical reviewer, Please note that the technical review may identify additional omissions or require additional information.
Please provide to this office within 30 days of your receipt of this card
A copy of your action has been forwarded to our License Fee & Accounts Receivable Branch, who will contact you separately if there is a fee issue involved.
Your action has been assigned Mail Control Number 13 73944- When calling to inquire about this action, please refer to this control number. You may call us on (61 0) 337-5398, or 337-5260.
NRC FORM 532 (RI)
('3-96)
Sincerely, Licensing Assistance Team Leader