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Health Facility
Biomedical Engineer
Name
*
Type
*
---------
Hospital
Clinic
Facility type
*
---------
Public
Private
FBO
NGO
Level
---------
I
II
III
IV
V
Specialty
Ppb id
Branch name
*
Physical/Postal address
Location
*
Account Manager Details
First name
*
Last name
*
Badge/Hiring No.
*
The unique ID assigned by the health facility. (Or national ID)
Designation
*
The position you hold in the health facility.
Phone number
*
Email
*
Password
*
Confirm Password
*
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