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ISIIC Study : International Survey to Investigate the Implementation of ICU daily care for COVID-19
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Email
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病院名/ hospital name
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ICU名/ name of ICU
*
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Your answer
担当者氏名/ Representative of your ICU to this study
*
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Your answer
所属診療科/department
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職種/ type of job (doctor, nurse,physiotherapist, ,,etc.)
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メールアドレス/E-mail adress
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コメント/ comments
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