SECOND ANNUAL INSURANCE LEADERSHIP SUMMIT JUNE 13

Transcripción

SECOND ANNUAL INSURANCE LEADERSHIP SUMMIT
JUNE 13-15, 2012
TRAVEL AND ACCOMMODATION REGISTRATION
Baptist Health South Florida will sponsor the round trip airfare and hotel stay for the duration of the conference
Wednesday, June 13 through Friday, June 15 (2 nights) at The Ritz-Carlton, Coconut Grove Miami.
All incidentals including “additional” meals will be the responsibility of the attendee.
Airline tickets will be reserved with American Airlines Group Reservations Department directly.
The following information outlines the flight dates and estimated time of day that will be booked for your travel to Miami, FL for the conference.
Please review the proposed travel dates listed below and advise of any changes accordingly.
Local Attendees – Accommodations
Baptist Health South Florida will sponsor your hotel stay for the duration of the conference
IMPORTANT:
Any requests for changes to reserved travel itineraries will incur a change fee by American Airlines. Baptist Health South Florida will
not be paying for the change fee and will request a personal credit card that the charges can be applied to if applicable.
A Travel Confirmation Letter detailing your flight itinerary and hotel confirmation number will be sent to the email address
provided in the registration form as the event draws closer.
Date of Departure and
Arrival to Miami:
Wednesday, June 13, 2012
Departure Airport:
Please include country, city, state and name of airport.
Time of Desired Flight:
Note: Morning flights will be booked unless otherwise specified.
Date of Departure from
Miami:
TRANSPORTATION
Please note that Baptist Health South Florida will not be providing transportation to and from the airport and
hotel. However, below we have listed several transportation resources you may contact at your leisure.
• Taxicabs are readily available on a first come first serve basis. Taxicabs are available only on the
arrival / lower (ground) level of the airport, outside of the baggage claim areas.
• Car Rental Shared Buses/Shuttles are available to pick up guests and transport them to the RCC
– Rental Car Center. These buses may be accessed on the arrival / lower (ground) level of the
airport. Please refer to link below for additional information and a list of rental car companies.
http://www.miami-airport.com/car_rental.asp
• Super Shuttle vans are available only on the arrival / lower (ground) level of the airport, outside of the
baggage claim areas. You may contact them directly in advance to make a reservation at
305-871-2000.
http://www.supershuttle.com/en/MIAAirportShuttleMiami
• If you would like private transportation services you may contact Aventura Worldwide Transportation
Services at 1-800-944-9886 to coordinate your service of choice. Aventura is the preferred
transportation company of The Ritz-Carlton, Coconut Grove.
Baptist Health International personally cares for the special needs of international
patients. The program is one of the leading and largest hospital-based centers for
international patients in the United States. Its multilingual employees have
redefined the concept of customer service by providing assistance in coordinating
hospital admissions, outpatient testing and physician consultations, as well as
personal needs. Each year, more than 12,000 people, primarily from Latin America
and the Caribbean, travel to Baptist Health facilities to receive the finest medical care.
http://www.aventuralimo.com
HOTEL INFORMATION
The Ritz-Carlton, Coconut Grove
3300 Southwest Twenty-Seventh Avenue, Coconut Grove, FL 33133
Telephone: 305-644-4680
http://www.ritzcarlton.com/en/Properties/CoconutGrove
Friday, June 15, 2012
The Second Annual Insurance Leadership Summit will take place at the luxury, boutique hotel The Ritz-Carlton, Coconut Grove
Miami. With its charming, villa-like ambience, the hotel is an urban retreat in the heart of one of the city’s most enchanting
neighborhoods, known for its shopping, dining, sailing, proximity to family attractions and myriad festivals and events. With
soaring ceilings, Venetian stucco columns, fragrant roses, grand fireplace and picturesque views, it is a relaxing retreat for
business or leisure travel. Savor Italian cuisine in Bizcaya lounge, renowned for its Mediterranean-influenced fare and the area’s
only contemporary Latin live music venue, or be pampered in the city’s finest Boutique Spa. Vibrant Coral Gables, South Beach,
the cultural attractions of Downtown Miami and the Miami International Airport are all easily accessible.
Time of Return Flight:
Note: Afternoon flights (i.e. 6:00 p.m.) will be booked unless otherwise specified –
the meeting concludes at 1:30pm on June 15, 2012.
American Airlines
Advantage Member #:
Please provide reward number if applicable.
Hotel Information:
The Ritz-Carlton, Coconut Grove Miami - 3300 Southwest 27 Avenue, Coconut Grove, Florida 33133 - 305-644-4680
http://www.ritzcarlton.com/en/Properties/CoconutGrove/Default.htm
Escape to the peaceful, rejuvenating solitude of The Ritz-Carlton Boutique Spa at Coconut Grove, Miami. This sanctuary of
beauty and wellness is renowned for its personalized service on an intimate scale. A comprehensive selection of massage
techniques, body treatments, modern facial care and precision nail services is enhanced by tranquil surroundings and superior
Ritz-Carlton service. Enjoy a 10% discount off all spa services as a guest of Baptist Health International.
Check-In Date:
Check-Out Date:
ATTIRE
Baptist Health South Florida is the largest not-for-profit healthcare organization in
the region. Affiliates of Baptist Health include Baptist Hospital of Miami, Baptist
Children’s Hospital, South Miami Hospital, Homestead Hospital, Mariners Hospital,
Doctors Hospital, West Kendall Baptist Hospital, Baptist Cardiac & Vascular Institute
and Baptist Outpatient Services.
SPA INFORMATION
Check-In Time:
Check-Out Time:
3:00 p.m.
12 noon
King Bed
Two Queen Beds
(please make appropriate selections)
NOTE: Room preference cannot be guaranteed.
NOTE: Baptist Health South Florida will be providing complimentary accommodations for International Attendees
for 2 nights on Wednesday, June 13 and Thursday, June 14.
The group discount rate of $214 per night will be available for reservation extensions 3 days before and after the
conference dates. Reservation extensions and all incidentals will be charged to each guest’s room folio directly and
will require a credit card upon check-in.
Attire for the summit educational sessions is business. Please bring a sweater or jacket since the meeting room temperature
and personal comfort levels vary.
Attire for the welcome cocktail reception and dinner is business casual.
PARKING
Complimentary valet parking will be available to all Local Attendees. Validations will be provided daily at the registration desk.
[email protected] • baptisthealth.net/international
786-596-2373
JUNE 13-15, 2012
The Ritz-Carlton, Coconut Grove, Florida
AUDIENCE
Chief Executives, Presidents, Manager General and Medical Directors of International Health Insurance
Companies.
AGENDA
6:30 - 8:30 p.m.
• Gain knowledge about Baptist Health’s dynamic blend of leading-edge medical care,
continuous investment in the latest technology and timeless commitment to our patients.
• See our comprehensive coordination of world-class care with our exclusive service to the
international insurance sector.
8:00 - 9:00 a.m.
Breakfast Buffet
Leisure Time… Enjoy the time to shop, swim, take a nap or have a rejuvenating spa treatment
9:00 - 9:15 a.m.
Welcome and Introductions
Welcome Cocktail Reception
9:15 - 9:30 a.m.
Opening Remarks
George W. Foyo, Executive Vice President and Chief Administrative Officer,
Baptist Health South Florida
8:00 - 9:00 a.m.
Breakfast Buffet
9:00 - 9:15 a.m.
9:15 - 9:45 a.m.
Opening Remarks “Baptist Health International”
Mario A. Méndez, M.D., Corporate Vice President and Chief Medical Officer,
Baptist Health International
9:45 - 10:00 a.m.
“Our Name is Health” Baptist Health South Florida
Brian E. Keeley, President and Chief Executive Officer, Baptist Health South Florida
10:00 - 10:30 a.m.
“The International Patient Experience”
Yohandra Fuentes, Assistant Vice President of International Insurance and Revenue Management
10:30 - 11:00 a.m.
Coffee Break
11:00 - 11:30 a.m.
“Advanced Treatment of Brain Tumors without Surgery” Doctors Hospital Gamma Knife Center
Harold J. Pikus, M.D., Medical Director of the Radiosurgery Program, Division of Neurosurgery
for the Baptist Health Neuroscience Center and the Medical Director for Gamma Knife and
Neurosurgery at Doctors Hospital
• Tour our facilities and see first hand Baptist Health’s acclaimed patient and family centered care.
Friday, June 15 – Session II
Hospitality Desk & Registration Opens
Thursday, June 14 – Session I
OBJECTIVES
During this summit, participants will be able to:
• Learn about Baptist Health’s history of providing the highest standards in service and quality to
the insured international patient coupled with ground breaking outcomes.
SUMMIT REGISTRATION
Wednesday, June 13 – Arrivals
12 noon - 4:00 p.m.
OVERVIEW
Baptist Health South Florida is the recognized healthcare leader serving many international communities.
Every year, thousands of international patients travel to Baptist Health facilities seeking specialized
medical care. For over a decade, Baptist Health has been selected by patients as a preferred provider
because of its high-quality medical professionals and leading-edge technologies. Our dedication and
commitment to excellent customer service has been the foundation in building long lasting relationships with patients, referring physicians and insurers from the international community. This goes
hand in hand with the international insurance industry’s desire to provide their members with a
healthcare system that delivers quality, evidence-based medical care, excellent patient customer
services and competitive pricing.
JUNE 13-15, 2012
Panel Discussion / Q & A
• Get acquainted with our executives and medical staff in order to develop and strengthen
professional relationships.
11:30 - 12 noon
12 noon - 1:30 p.m.
Lunch
• Take advantage of this excellent opportunity to network with senior level colleagues in the
international insurance industry.
2:00 p.m.
Shuttle pick up for Tour of West Kendall Baptist Hospital
2:45 p.m.
Arrival at West Kendall Baptist Hospital for Tour
4:45 p.m.
Shuttle pick up to return to The Ritz-Carlton, Coconut Grove
5:30 p.m.
Arrival at The Ritz-Carlton, Coconut Grove
9:30 - 10:00 a.m.
“The Impact of the US Healthcare Reform on the International Medical Insurance Business”
Ralph E. Lawson, Executive Vice President and Chief Financial Officer,
10:00 - 10:30 a.m.
Coffee Break
10:30 - 11:00 a.m.
“Revolutionizing The Experience of Surgery” South Miami Hospital Center for Robotic Surgery
Troy A. Gatcliffe, M.D., FACOG, FACS, Gynecologic Oncologist
11:00 - 11:30 a.m.
11:30 - 11:45 a.m.
Date
Name (Please ensure the name printed matches the legal name on ID/PASSPORT as
required by travel regulations.)
Degree / Professional Designation (i.e. M.D., Ph.D.,
R.N., etc.)
Date of Birth
MM
DD
Business Telephone
Closing Remarks
Lunch
Male
Passport Number
Passport Exp. Date
Female
Business Title
Address Line 2
“International Insurance Market Development”
12:15 - 12:30 p.m.
YYYY
Passport Country of Origin
Mailing Address
City
Sex
Company Name
“Challenges and Opportunities of Vertical Integration in Healthcare”
Carlos Ariza, Assistant Vice President Market Analysis & Development,
11:45 a.m. - 12:15 p.m.
12:30 – 1:30 p.m.
PARTICIPANT INFORMATION
State
Postal Code / Zip Code
Cell Phone
Business E-mail Address (Please print clearly.)
Fax
Personal Email Address (Please print clearly.)
• Will you need Simultaneous Translation during the conference?
• Will you require a Visa Travel Letter?
Country
Yes
Yes
No
No
*The decision to issue a visa is the sole judgment of the local embassy or consulate. Baptist Health South Florida is not able to assist with the actual visa process.
SUMMIT HOSPITALITY DESK:
Upon your arrival to The Ritz-Carlton, Coconut Grove Miami, a Baptist Health International Representative will be available to facilitate your
registration for the summit. For more information on how to access the Summit Hospitality Desk, please ask the guest services agent upon check-in.
SPECIAL NEEDS:
In consideration of the Americans with Disabilities Act, please check here if you require special services,
and we will contact you to determine your specific requirements.
Registration Deadline: May 11, 2012
Leisure Time… Relax and enjoy your afternoon
7:30 - 10:00 p.m.
Return this completed form to:
1575 San Ignacio Avenue, Suite 406, Coral Gables, FL 33146
Fax: 786-533-9714
E-mail: [email protected]
Cocktail Reception and Dinner
PLEASE NOTE: The presentation topics and speakers may be subject to change.
For additional information, please contact the Baptist Health International Department at 786-467-5447 or email [email protected]
AUDIENCE
Companies.
AGENDA
6:30 - 8:30 p.m.
8:00 - 9:00 a.m.
Breakfast Buffet
9:00 - 9:15 a.m.
9:15 - 9:30 a.m.
Opening Remarks
8:00 - 9:00 a.m.
Breakfast Buffet
9:00 - 9:15 a.m.
9:15 - 9:45 a.m.
9:45 - 10:00 a.m.
10:00 - 10:30 a.m.
10:30 - 11:00 a.m.
Coffee Break
11:00 - 11:30 a.m.
OBJECTIVES
SUMMIT REGISTRATION
12 noon - 4:00 p.m.
OVERVIEW
JUNE 13-15, 2012
11:30 - 12 noon
12 noon - 1:30 p.m.
Lunch
2:00 p.m.
2:45 p.m.
4:45 p.m.
5:30 p.m.
9:30 - 10:00 a.m.
10:00 - 10:30 a.m.
Coffee Break
10:30 - 11:00 a.m.
11:00 - 11:30 a.m.
11:30 - 11:45 a.m.
Date
R.N., etc.)
Date of Birth
MM
DD
Business Telephone
Closing Remarks
Lunch
Male
Passport Number
Passport Exp. Date
Female
Business Title
Address Line 2
12:15 - 12:30 p.m.
YYYY
Mailing Address
City
Sex
Company Name
11:45 a.m. - 12:15 p.m.
12:30 – 1:30 p.m.
State
Cell Phone
Fax
Country
Yes
Yes
No
No
SPECIAL NEEDS:
7:30 - 10:00 p.m.
Fax: 786-533-9714
AUDIENCE
Companies.
AGENDA
6:30 - 8:30 p.m.
8:00 - 9:00 a.m.
Breakfast Buffet
9:00 - 9:15 a.m.
9:15 - 9:30 a.m.
Opening Remarks
8:00 - 9:00 a.m.
Breakfast Buffet
9:00 - 9:15 a.m.
9:15 - 9:45 a.m.
9:45 - 10:00 a.m.
10:00 - 10:30 a.m.
10:30 - 11:00 a.m.
Coffee Break
11:00 - 11:30 a.m.
OBJECTIVES
SUMMIT REGISTRATION
12 noon - 4:00 p.m.
OVERVIEW
JUNE 13-15, 2012
11:30 - 12 noon
12 noon - 1:30 p.m.
Lunch
2:00 p.m.
2:45 p.m.
4:45 p.m.
5:30 p.m.
9:30 - 10:00 a.m.
10:00 - 10:30 a.m.
Coffee Break
10:30 - 11:00 a.m.
11:00 - 11:30 a.m.
11:30 - 11:45 a.m.
Date
R.N., etc.)
Date of Birth
MM
DD
Business Telephone
Closing Remarks
Lunch
Male
Passport Number
Passport Exp. Date
Female
Business Title
Address Line 2
12:15 - 12:30 p.m.
YYYY
Mailing Address
City
Sex
Company Name
11:45 a.m. - 12:15 p.m.
12:30 – 1:30 p.m.
State
Cell Phone
Fax
Country
Yes
Yes
No
No
SPECIAL NEEDS:
7:30 - 10:00 p.m.
Fax: 786-533-9714
JUNE 13-15, 2012
IMPORTANT:
Arrival to Miami:
Departure Airport:
Miami:
TRANSPORTATION
305-871-2000.
HOTEL INFORMATION
Telephone: 305-644-4680
American Airlines
Advantage Member #:
Hotel Information:
Check-In Date:
Check-Out Date:
ATTIRE
SPA INFORMATION
Check-In Time:
Check-Out Time:
3:00 p.m.
12 noon
King Bed
Two Queen Beds
PARKING
786-596-2373
JUNE 13-15, 2012
JUNE 13-15, 2012
IMPORTANT:
Arrival to Miami:
Departure Airport:
Miami:
TRANSPORTATION
305-871-2000.
HOTEL INFORMATION
Telephone: 305-644-4680
American Airlines
Advantage Member #:
Hotel Information:
Check-In Date:
Check-Out Date:
ATTIRE
SPA INFORMATION
Check-In Time:
Check-Out Time:
3:00 p.m.
12 noon
King Bed
Two Queen Beds
PARKING
786-596-2373
JUNE 13-15, 2012
JUNE 13-15, 2012
AUDIENCE
Companies.
AGENDA
12 noon - 4:00 p.m.
OVERVIEW
6:30 - 8:30 p.m.
8:00 - 9:00 a.m.
Breakfast Buffet
9:00 - 9:15 a.m.
9:15 - 9:30 a.m.
Opening Remarks
8:00 - 9:00 a.m.
Breakfast Buffet
9:00 - 9:15 a.m.
9:15 - 9:45 a.m.
9:45 - 10:00 a.m.
10:00 - 10:30 a.m.
10:30 - 11:00 a.m.
Coffee Break
11:00 - 11:30 a.m.
OBJECTIVES
SUMMIT REGISTRATION
11:30 - 12 noon
12 noon - 1:30 p.m.
Lunch
2:00 p.m.
2:45 p.m.
4:45 p.m.
5:30 p.m.
9:30 - 10:00 a.m.
10:00 - 10:30 a.m.
Coffee Break
10:30 - 11:00 a.m.
11:00 - 11:30 a.m.
11:30 - 11:45 a.m.
Date
R.N., etc.)
Date of Birth
MM
DD
Business Telephone
Closing Remarks
Lunch
Male
Passport Number
Passport Exp. Date
Female
Business Title
Address Line 2
12:15 - 12:30 p.m.
YYYY
Mailing Address
City
Sex
Company Name
11:45 a.m. - 12:15 p.m.
12:30 – 1:30 p.m.
State
Cell Phone
Fax
Country
Yes
Yes
No
No
SPECIAL NEEDS:
7:30 - 10:00 p.m.
Fax: 786-533-9714
ACKNOWLEDGMENT OF CONFIDENTIALITY
Baptist Health South Florida (“BHSF”) takes seriously its obligations to maintain the confidentiality of patient information
under federal and Florida privacy laws and regulations. As a member of the temporary workforce of a BHSF facility or as an
independent contractor performing services on the premises of a BHSF facility, you may need to access patient information
in the course of performing your responsibilities at our facilities. You also may inadvertently come into contact with patient
information because of your presence at a BHSF facility. By signing this Confidentiality Agreement below, you acknowledge
that, as a condition of your access to patient information or your presence at a BHSF facility, you have read and agree to
comply with our policies and procedures regarding the confidentiality of patient information and the requirements set forth below.
DEFINITION OF PATIENT INFORMATION:
For purposes of this acknowledgment and agreement, “patient information” shall include demographic information, and means
information created or received by a BHSF facility that:
1) relates to the past, present or future physical or mental health or condition of an individual; the provision of health
care to an individual; or the past, present or future payment for the provision of healthcare to an individual; and
2) identifies the individual subject of the information or with respect to which there is a reasonable basis to believe
the information could be used to identify the individual subject of the information.
CONFIDENTIALITY REQUIREMENTS:
1) I have been informed about and understand applicable BHSF policies and procedures regarding the confidentiality
of patient information.
2) I will comply with all applicable laws, BHSF’s policies and procedures regarding the confidentiality of patient
information, and the confidentiality requirements listed below.
3) I will access patient information only as necessary to perform my responsibilities as a member of the temporary
workforce of a BHSF facility or as an independent contractor performing services on the premises of a BHSF facility.
4) I will not record, discuss or otherwise divulge any patient information other than as necessary in the course of my
duties and responsibilities for the BHSF facility.
5) I will guard and maintain the confidentiality of patient information, including, but not limited to, keeping patient
information secure, private and out of public view, and avoiding conversations about patient information except as
necessary to perform my responsibilities at a BHSF facility.
6) I will immediately report to the BHSF Privacy Officer any uses and disclosures or attempted uses and disclosures of
patient information that do not comply with applicable law, these confidentiality requirements or the BHSF facility’s
confidentiality policies and procedures.
7) I will immediately report to the BHSF Privacy Officer any breach or threat to the security of patient information of
which I become aware.
8) I understand that I may be terminated from working at or for a BHSF facility if I do not comply with any provision of
applicable law, these confidentiality requirements, or the BHSF facility’s confidentiality policies and procedures.
_______________________________________________
Signature
______________________________________________
Date
_______________________________________________
______________________________________________
Name of Visitor/Workforce Member (Please Print)
Department
_______________________________________________
______________________________________________
Department Personnel Name
Phone Number
_________________________________________________________________________________________________
Reason for Visit (if applicable)
Baptist Health facility:G Baptist Hospital G South Miami Hospital
G Doctors Hospital G Homestead Hospital
G Mariners Hospital G Baptist Outpatient Services G West Kendall Baptist Hospital
G Other: ____________________________
Privacy Office
Use Only:
Please fax this form to the Privacy Office at 786-662-7830.
Date Received:________________
BHSF #6041 Rev. 11/10
RECONOCIMIENTO DE CONFIDENCIALIDAD
Baptist Health South Florida (“BHSF”) se toma muy en serio sus obligaciones de mantener la confidencialidad de la información
sobre pacientes de acuerdo con las leyes y los reglamentos de confidencialidad federales y estatales de la Florida. Como
miembro temporal del cuerpo laboral de un local de BHSF o como contratista independiente que proporciona servicios en un
local de BHSF, es posible que necesite acceder a la información sobre pacientes en el curso de realizar sus responsabilidades
en nuestros locales. También es posible que inadvertidamente entre en contacto con la información sobre pacientes debido
a su presencia en un local de BHSF. Al firmar este Acuerdo de confidencialidad debajo, usted reconoce que, como una
condición de su acceso a información sobre pacientes o su presencia en un local de BHSF, ha leído y está de acuerdo con
acatar nuestras políticas y procedimientos en relación a la confidencialidad de la información sobre pacientes y los requisitos
establecidos presentados debajo.
DEFINICIÓN DE INFORMACIÓN SOBRE PACIENTES:
Para los propósitos de este reconocimiento y acuerdo, la “información sobre pacientes” incluirá la información demográfica,
y significa información creada o recibida por un local de BHSF que:
1) se relaciona al pasado, presente o futuro de la salud o del estado físico o mental de un individuo; la provisión de
atención de salud a un individuo; o el pago pasado, presente o futuro por la provisión de atención médica de un
individuo; y
2) identifica al individuo relacionado con la información, o con respecto al cual existe una base razonable para creer
que la misma se podría usar para identificar al individuo relacionado con la información.
REQUISITOS DE CONFIDENCIALIDAD:
1) Se me ha informado en relación a, y comprendo, las políticas y procedimientos correspondientes de BHSF en relación
a la confidencialidad de la información sobre pacientes.
2) Acataré todas las leyes correspondientes, las políticas y procedimientos de BHSF con respecto a la confidencialidad
de la información sobre pacientes y todos los requisitos de confidencialidad enumerados debajo.
3) Accederé a la información sobre pacientes solamente según sea necesario para realizar mis responsabilidades como
miembro temporal del cuerpo laboral de un local de BHSF o como contratista independiente proporcionando servicios
en un local de BHSF.
4) No apuntaré, discutiré, ni divulgaré de otro modo ninguna información sobre los pacientes diferente de aquella que
sea necesaria en el curso de mis deberes y responsabilidades para el local de BHSF.
5) Protegeré y mantendré la confidencialidad de la información sobre los pacientes, incluyendo, pero sin limitarse a,
mantener segura, privada y fuera de la vista pública, la información sobre los pacientes, y evitaré conversaciones
acerca de la información sobre los pacientes salvo que esto fuera necesario para realizar mis responsabilidades
en un local de BHSF.
6) Inmediatamente informaré al oficial de confidencialidad de BHSF sobre cualquier uso y divulgación, o sobre cualquier
intento de usar y divulgar, información sobre los pacientes que no cumplan con la ley correspondiente, con estos requisitos
de confidencialidad o con las políticas y procedimientos referentes a la confidencialidad del local de BHSF.
7) Inmediatamente informaré al oficial de confidencialidad de BHSF acerca de cualquier violación o amenaza a la seguridad
de la información sobre los pacientes de la cual me enteré.
8) Comprendo que tal vez se me despida de trabajar en o por un local de BHSF si no cumplo con cualquier disposición de
ley correspondiente, con estos requisitos de confidencialidad o con las políticas y procedimientos del local de BHSF.
_______________________________________________
Firma
______________________________________________
Fecha
_______________________________________________
______________________________________________
Nombre del visitante/miembro del personal
Departamento
Nombre del personal del departamento
Número de teléfono
_______________________________________________
______________________________________________
_________________________________________________________________________________________________
Motivo de la visita (si corresponde)
Local de Baptist Health: G Baptist Hospital
G South Miami Hospital
G Doctors Hospital G Homestead Hospital
G Mariners Hospital G Pacientes Externos de Baptist Servicios G West Kendall Baptist Hospital
G Otro: _____________________________
Uso solamente de la oficina de confidencialidad:
Por favor envíe este formulario por facsímil
a la oficina de confidencialidad al 786-662-7830.
Fecha recibida:________________
JUNE 13-15, 2012
IMPORTANT:
Arrival to Miami:
Departure Airport:
Miami:
TRANSPORTATION
305-871-2000.
HOTEL INFORMATION
Telephone: 305-644-4680
American Airlines
Advantage Member #:
Hotel Information:
Check-In Date:
Check-Out Date:
ATTIRE
SPA INFORMATION
Check-In Time:
Check-Out Time:
3:00 p.m.
12 noon
King Bed
Two Queen Beds
PARKING
786-596-2373
JUNE 13-15, 2012

SECOND ANNUAL INSURANCE LEADERSHIP SUMMIT JUNE 13

Transcripción

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