ESOI Membership Registration | ECMO Society Of India

+91 22-28663984/85
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Riddhi Vinayak MultiSpeciality Hospital,
Near Railway Carshed Yeshwant Gaurav Road,
Nallasopara (W), Maharashtra 401203.

Application form for ECMO Centre affiliation to ECMO SOCIETY OF INDIA

Institution Name: *

Email: *

Pin Code: *

Website:

Institute Address: *

State

City

Phone: *

Fax:

Year In Which Established:

Total Number Of Beds In The Hospital:

Status Of Hospital:

5. ECMO program initiated in Institute in which year –

6. Is your center a member of the Extracorporeal Life Support Organization (ELSO) :

Yes No

7. How many patients have been supported with ECLS at your center per year in the last 5 years

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