Foundations of Managing Healthcare Business Executive Programme - Application Form

Foundations of Managing Healthcare Business Executive Programme – Application FormCharles Bodo2022-04-06T15:09:52+03:00

Foundations of Managing Healthcare Business Executive Programme - Application Form

PLEASE COMPLETE IN BLOCK CAPITALS
Family Name:*
Other Names:*
Cell Phone Number:
Email address:
Date of Birth:*
Country of Residence:*
Nationality:*
Industry*
Name of Organization you are currently working at:*
Designation in the Organization:*
PROFESSIONAL DEVELOPMENT
Have you attended any formal training/professional program on Managing a Healthcare Business?*
- Yes
- No
Are you responsible for professional development in your organization? (training, capacity building etc)?*
- Yes
- No
Sub-sector in which your healthcare business is operating.*
- Pharmaceutical Industry
- Hospital - Private sector (both inpatient and outpatient services)
- Hospital - Public sector (both inpatient and outpatient services)
- Hospital - Faith based (both inpatient and outpatient services)
- Hospital - Private sector (outpatient services only)
- Hospital - Faith based (outpatient services)
- Doctor's stand-alone clinic
- Community Pharmacy/Retail Pharmacy/Chemist
- Nurse Clinic
- Laboratory
- Healthcare Research & Academia
- Healthcare Consultancy
- Other - please specify
If Others Kindly Specify:*
Your Healthcare Business Relationship*
- Investor in the Business
- Owner and Manager running the Business
- Manager in the Business but not owner
- Employee in the business
- Employee with a healthcare business as a side hustle
- Employee looking to start a healthcare business
- Not employed and looking to start a healthcare business
How many years have you spent in your role in Q2 above?*
If you are the owner or investor in the healthcare business, how many years have you had the business?*
How many employees are in the Healthcare Business?*
Where is your Healthcare Business located?*
- Rural setting
- Rural/Urban setting
- Urban setting
- Low income setting
- Mid income setting
- High income setting
What mode of payment is used in your Healthcare Business?*
- Cash - Direct/Bank Transfer
- Mpesa/Airtel Money
- Visa/Mastercard/Other Card Payments
- Insurance - private
- NHIF
What is the dominant mode of payment used in your healthcare business?*
- Cash - Direct/Bank Transfer
- Mpesa/Airtel Money
- Visa/Mastercard/Other Card Payments
- Insurance - private
- NHIF
What percentage does the dominant mode of payment take?*
As a Healthcare Business, which operations do you think need urgent attention?*
- IT
- Finance and Accounts
- Human Resources
- Procurement
- Stocks Management
- Customer service
- Others, please specify
If Others please Specify:*
Does your Healthcare Business Have the following clearly stated?
Mission*
- Yes
- No
Vision*
- Yes
- No
Core Values*
- Yes
- No
Code of Conduct*
- Yes
- No
Service Charter*
- Yes
- No
What are the 3 things you think are stopping your healthcare business from growing?*
HEALTHCARE ENTREPRENEUR RELATED
How many years have you been in business?*
What are the 3 things you hope the MHB Program will help you address?*
Which MHB Program Option would you be interested in attending?*
Any other information you would like to clarify/inquire about?*
CANCELLATION POLICY
All cancellations must be made in writing to the Program Manager. Cancellations made less than 14 days to thecommencement of the seminar, are subject to a penalty of 25% of total program fee.
- I agree to the terms of the cancellation policy as detailed above.
Date:*
Would you like to receive our weekly newsletter (At a Glance)?*
- Yes
- No
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Foundations of Managing Healthcare Business Executive Programme – Application Form

Foundations of Managing Healthcare Business Executive Programme - Application Form

PLEASE COMPLETE IN BLOCK CAPITALS

PROFESSIONAL DEVELOPMENT

Does your Healthcare Business Have the following clearly stated?

HEALTHCARE ENTREPRENEUR RELATED

CANCELLATION POLICY

A Culture of Ethics & Learning

SBS PARTNERS

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Resources

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