bringing hope those in despair - aphc2019.com · (prof husni tanra) 09.10 – 10.10 family support...

Bringing Hope to

THE 13 ASIA PACIFIC HOSPICEAND PALLIATIVE CARE CONFERENCE

st th

Those in Despair

th

SECOND ANNOUNCEMENT

APHC 201913th ASIA PACIFIC HOSPICE CONFERENCE

SURABAYA - INDONESIA

Greeting 2

About APHC 2019 3

Committee 4

General Information 5

Workshop 6

Symposium 7

Abstract Submission Guidelines 10

Registration & Accommodation 14

International Flight 15

Tourism 17

Registration Form 18

Accommodation Form 19

Table of Content

2

www.aphc2019.com The 13th Asia Pacific Hospice Conference, 2019, SURABAYA - INDONESIA



Greeting

On behalf of the APHC 2019 Organising Committee, we kindly invite you to attend the conference. This is the first APHC conducted in Indonesia and will be held in the city of Surabaya. Why in Surabaya? Surabaya is the place where palliative care organisations and services, as well as training has been conducted and are spreading to several cities in Indonesia.

Palliative care is a relatively new field of medicine in Indonesia that is not yet widely known. We have to consider that every patient with life threatening diseases will need palliative care at the last phase of their life. Having the theme “Bringing Hope to Those in Despair” for APHC 2019, it is hoped that the problems and challenges associated with palliative care development in Indonesia and the region can be solved through sharing of expertise and experience by world renowned experts during this conference. We hope that by holding APHC in Indonesia, palliative care can be better known in our country, advancing palliative care developments and in turn result in the building of better, more professional services.

The conference is co-organised by the Indonesian Palliative Society (MPI) and the Asia Pacific Hospice Palliative Care Network (APHN). It can be attended by general practitioners and specialists, nurses, pharmacists and other healthcare professional, medical and nursing students, and volunteers.

The APHC 2019 and its related activities is Surabaya has supported by the Provincial Government of East Java, the Ministry of Health and the Ministry of Tourism. We are pleased to invite you to enjoy the beautiful sights and our unique culture, as well as to visit the medical, tourism, industrial exhibitions.

Looking forward to your attendance and participation in APHC 2019 that will be held on 1st to 4th August 2019 at the Grand City Convention Center in Surabaya. Further information about the conference can be accessed through our official website at www.aphc2019.com See you at APHC 2019

Dradjat R.Suardi, MD, FICS,Chairman, Organising Committee of APHC 2019


3APHC 201913th ASIA PACIFIC HOSPICE CONFERENCE


After the 12th APHC in Singapore in 2017, Indonesia – through The Indonesian Palliative Society (MPI) – has expressed their willingness to host The 13th Asia Pacific Hospice Palliative Care Conference 2019. Indonesia understands the importance of its role in the Asia Pacific region to participate in the update of science and knowledge on palliative care.

As an initiator of palliative science and knowledge progress in Indonesia, Surabaya has been appointed as the next host in this biennial event. The local team has been utilising all existing resources and getting ready the facilities and infrastructure to meet the standards of a world class event. From event execution, safety and comfort of the participants, to supporting facilities such as tourist attractions, Surabaya is prepared to welcome The 13th

Asia Pacific Hospice Palliative Care Conference 2019 participants.

With the trust that has been given and the remaining time, Indonesia is optimistic that the 13th Asia Pacific Hospice Palliative Care Conference 2019 will go well and achieve the optimum result.

About APHC 2019




General Information

Event Place GRAND CITY CONVENTION & EXHIBITION

Jalan Walikota Mustajab No.1, Ketabang, Genteng, Surabaya, Jawa Timur 60272 Indonesia

Phone: (031) 5459000

Event Schedule• SCIENTIFIC WORKSHOP

August 1st 2019

• SCIENTIFIC SYMPOSIUM

August 2nd - 4th 2019

• MEDICAL EXHIBITION

August 2nd - 4th 2019

INDONESIAN PALLIATIVE SOCIETY

c/o Palliative Care Building

Dr. Soetomo General Hospital Surabaya

Jl. Mayjend Prof. Dr. Moestopo No. 6 - 8, Surabaya, Jawa Timur 60285

Phone : +62 315018840, +62 31 5501089

Fax : +62 31 5018840

Email : [email protected]

Thursday, August 1st 2019

6




Pre Conference Workshop APHC 2019

Time

07.00 - 08.00

09.00 - 09.30

The integration of oncology and palliative care (IOP):

An evidence update (dr David Hui)

09.00 - 09.30

Pain Management in Chronic Conditions versus

Palliative Care Setting (dr. Wiwiek Indriyani)

08.00 – 09.00Overview in Palliative Care

(dr. Siti Annisa Nuhonni SpKFR-K)

09.30 - 09.50

The current status of palliative care in the Asia-

Pacific region(dr. Takashi Yamaguchi)

09.30 - 10.00

Understanding Pain Pathway in The Context of Total Pain (International

speaker)

09.00 – 09.10 Discussion

09.50 - 10.05 Coffee Break 10.00 - 10.30Assessment of chronic and

cancer pain (Prof Husni Tanra)

09.10 – 10.10

Family Support in Palliative Care

(dr. Agustina Konginan SpKJ)

10.30 -10.45 Coffee Break 10.10 – 10.20 Discussion

10.45 - 11.15

Pain pharmacotherapeutics as applied to palliative care

(Dr Naveen Salim)

10.20 – 10.30 Coffee Break

12.05 - 12.30

How to overcome challenges and implement

IOP in Asian countries: Future directions

(Panel Discussion)

11.15 - 11.45

Rationale analgesic prescribing in palliative

care (International speaker)

10.30 – 11.30 Grief and Bereavement (dr. T. Arimanto Yuwana, SpKJ)

11.45 - 12.15

Interventional pain management in palliative care setting (International

speaker) (Dr. Sushma)

11.30 – 11.40 Discussion

11.40 - 12.15 Case Discussion

13.00 - 14.00 Breathlesness 13.30-14.15The Challenge Of Chronic

Wound Management (Helen SKep, Ns ETN)

13.00 – 14.00Psychosocial Aspect in

Palliative Care (dr Maria Witjaksono,

14.00 - 15.00 Pain Asessment 14.15-15.00

Colostomy Management In Palliative Care

(Ria Anjarwaty SKep, Ns., ETN)

14.00 – 15.00The Last 48 Hours

(dr Erikavitri Yuwana SpKJ-K)

15.00 - 15.15 Coffee Break 15.00 - 15.15 Coffee Break 15.00 – 15.15 Coffee Break

15.15 - 16.15 Dementia 15.15-16.15 Dry workshop wound and stoma stage 1

15.15 – 16.15Medicolegal in Palliative

Care(Prof. Marlina)

16.15 - 17.15 Neurodegenerative Disorders

16.15-17.15 Dry workshop wound and stoma stage 2

16.15 - 17.15 Case Discussion

Room 1 Room 2 Room 3 Room 4 Room 5

Registration

Workshop 1A Workshop 2A Workshop 3A Workshop 4A Workshop 5A

Integration and Standard of Palliative Care in Clinical Oncology

Paediatric Palliative Care Mandarin Hospice Summit (Session conducted in Chinese)

Pain Management

Neonatal Palliative CareSpeaker: - dr. Chakra Vasuvedan

- dr. Edi Setiawan Tehuteru, SpA(K), MHA

dr. Marry Ann Muckaden

opening. Prof. Cynthia Goh

Regional Differences in Cultural, and Life & Death Perspectives of Hospice Palliative Care for the Ethnic Chinese. Speaker: Prof. Liu Duan Qi, Prof. Chun-

Kai Fang, 邀請中(TBA)(Hong Kong), 邀請中(TBA)

(Singapore)

Exploring the philosophy of Hospice Paliative Care Speaker: Prof. Liu Duan Qi, Prof. Chun-Kai Fang, 邀請中(TBA)

(Hong Kong), 邀請中(TBA)(Singapore)

Psychosocial, Spiritual Care and Therapeutic Communication in Palliative Care

(For Cadres, Volunteers, Caregivers)

10.05 - 12.05Scope, challenges, and opportunities of IOP in

Asian countries

Lunch

Workshop 1B Workshop 2B Workshop 3B Workshop 4B Workshop 5B

Psychosocial, Spiritual Care and Therapeutic Communication in Palliative Care

(for Doctors and Nurses)Comprehensive Assessment of Patient Paediatric Palliative Care (continue) Mandarin Hospice Summit (Continue) Wound and Stoma Care

sharing of findings and experiences: speaker (Haidian Beijing, putuo

shanghai, deyang sichuan, luoyang henan, changcun jilin, 印尼華人,

chinese in indonesia, 馬來西亞華人, chinese in malaysia)

Tea Break

Round table Discussion:Collaboration for the Ethnic Chinese under

the APHN Structure. Summit speaker

Closing Remarks : speaker Prof. Cynthia Goh

Neonatal Palliative CareSpeaker: - dr. Chakra Vasuvedan

- dr. Edi Setiawan Tehuteru, SpA(K), MHAdr. Marry Ann Muckaden

TIME

07.30 - 08.30

08.30 - 08.35

08.35 - 08.50

08.50 -08.55

08.55 -09.10

09.10 - 09.30

09.30 - 09.40

09.40 - 09.50

09.50 - 10.00

12.00 - 13.30 Lounge and Friday Prayer APHN Annual General Meeting Coffee Break, Exhibition, and Poster Viewing

13.30 - 14.30

Scientific Session 1 Educational Session 1 Scientific Session 2

Nausea And Vomitus(dr. Johan Kurnianda, SpPD, KHOM)

How can we maximize the use of antipsychotics?

(Prof. Meera Agar)

Anoreksia and Cacchexia(dr. Noorwati Sutandyo, SpPD, KHOM)

What is the role of benzodiazepines?(Dr. David Hui)

15.30 - 15.45

15.45 - 16.35 Satellite Symposium 1--> Heart Failure and Palliative Care

Satellite Symposium 2--> Dementia Satellite Symposium 3

Management of diabetic kidney failure

15.45 - 16.05 How is Heart Failure Different from cancer (Dr. Bakitas )

Psychiatric and behavioral problems Shared decision making in the appropriate Initiation of and withdrawal from dialysis

(Dr. Miura)

16.05 - 16.25Standard and symptomatic treatment for

palliative heart failure (Dr. Bakitas)

Caregiving of patient with dementia Palliative And End of Life Care For People

With Diabetes : Clinical Practice (Dr. Miura)

16.25 - 16.35 Q & A Q & A Q & A


Fatique(Prof. Karin Van Der Rijt (Erasmus Univ))

What is the best practice in non-pharmacological care

(Dr. Sayaka Takenouchi)

Nutrition Disorders Problems (dr. Fiastuti Witjaksono, M.S., SpGK)

Best practices in palliative sedation & refractory distress

(Dr. Takashi Yamaguchi)

18.00- 18.05

18.05 - 19.25

19.25 - 19.40

21.30 – 21.40

Symptoms Management Relief from Agitated Delirium at The End of

Life

Morphine and Methadone (dr. Suresh Reddy)

PLENARY 2

The Best Palliative Care in The Last 3 Days of Life: an Evidence-Based Update (Dr. David Hui)

10.00 - 11.00

11.00 - 12.00

EVENTS

Registration

08.30 – 10.00

Opening

Angklung Music Performance by Cancer Patient

Opening Speech (Dradjat R.Suardi, MD, FICS)

Welcome Speech for participant (Major of Surabaya Palliative City)

Keynote Speech "The Challenge of Palliative Care In Modern Technology Era"

( Prof. R. Sunaryadi Tejawinata,dr., SpTHT-KL(K-Onk). FICS. FAAO. PGD.Pall.Med (ECU))

APHN Speech (Prof. Chynthia Goh)

Opening Ceremony

Formal Speech (Minister of Health of Indonesia)

Cancer Pain Management : How to Make the Most of Inexpensive Analgesics

Opening

Speech of Chairman APHC 2019 (Dradjat R.Suardi, MD, FICS)

Speech from APHN

14.30 - 15.30

18.00 - 21.40

19.40 - 21.30

Faculty Dinner (Mojopahit Hotel) 100 person

16.35 - 17.35

Coffee Break, Exhibition, and Poster Viewing

Concurrent Session

Dinner and Entertainment

Palliative Volunteer Choir

Music

Closing by MC

Sustainable, effective pain management in a hospital setting

(Dr. Sushma BHATNAGAR)

Award for dr.ROSALIE SHAW (Urip Murtedjo,dr.,SpB-KL(K).FINASCS (K). FICS. PGD.Pall.Med (ECU))

PLENARY 1

Bringing Hope to Those in Despair: Communication in Advance Care Planning (Prof. Josephine Clayton (The University of Sydney- Sydney Medical School)

Sponsored Lunch Symposium - Mundi Pharma The use of oxocodon in cancer pain management

3 Concurrent Sessions

Friday, August 2nd 2019




THE 13th ASIA PACIFIC HOSPICEPALLIATIVE CARE CONFERENCE 2019

TIME

08.00 - 09.00

11.00 - 11.15

Scientific Session 3 Educational Session 2

Symptoms of Advanced Chronic Kidney Disease in Palliative Care

(dr. Frank Brennan)

Screening and Expert Management in HIV/AIDS Associated with Significant Level of

Physical and Psychological Symptoms (Prof. Dr. dr Syamsurizal Djauzi, SpPD-KAI)

12.15 - 13.30

Scientific Session 3 : Updates of major topics in palliative care

Educational Session 2 Scientific Session 4

Nurse Paliative Care

Improving Palliative Care Using Quality Indicators: Nurses’ Perspective

(dr. Maho Aoyama)

14.30 -15.30Quality improvement in palliative care (e.g., bereaved family survey, quality assessment)

(Prof. Mitsunori Miyashita)

The Quality of Life of Cancer Patients with Body Image and Sexual Dysfunction

(Christantie Effendy, PhD)

15.30 - 16.20 Satellite Symposium 4 --> Neurology(Dr. Mieko Ogino)

Satellite Symposium 5 --> Cirrhosis (Prof. L. A. Lesmana SpPD, KGEH)

15.30 - 15.50What is the role of Palliative

Care in Stroke? (dr. Kohino)

Palliative Care for People with Advanced Liver Disease: How to do it?

15.50 - 16.10What are special considerations are needed for patients with neurodegenerative disease

(dr. Kohino)

Advanced Pancreatic Billiary Cancer and Palliative Care : what is best for patients ?

16.10 - 16.20 Q & A Q & A

16.20 - 17.20Non cancer palliative care

(or Psychosocial issues of family in pall care)(Dr. Amy Chow)

The Challenges in End of Life Care (Prof. Carmen Chan

The Chinese University of Hongkong)

19.00 – 19.15

19.15 – 19.30

19.30 – 19.45

19.45 – 21.30

21.30 – 21.40

Visit to Hospice Palliative care

11.15 - 12.15

Pain management in non-cancer condition(Dr. Joanne Lyn)

19.00 - 21.40

Opening

Speech of Chairman APHC 2019 (Dradjat R.Suardi, MD, FICS)

FORMAL SPEECH(Major of Surabaya Palliative City)

Dinner + Performance (traditional dance)

Closing

Palliative care in intensive care units and emergency rooms

(Dr. Janis Miyaski, or will ask Dr. Akhilesh to nominate a speaker)

Prognostication (part 2: How to communicate prognosis +

future research direction)(Dr. Masanori Mori)

Q & A

13.30 - 14.00

14.00 - 14.30

Oral

Presentation

EVENTS

Concurrent Sessions

Scientific Session 4

Room are divided into : Oral presentation

Meet the expert (Plenary Speakers + Other Regional Experts)

Dr. Cynthia Goh /Dr. Ednin HamzahDr. Jim Cleary

Prof. David Currow Prof. Yoshiyuki KizawaProf. Tamura (nursing)

09.00 - 10.00


PLENARY 3

PLENARY 4

Hinohara Memorial lecture (Dr. Joanne Lynn)

Essential leadership skills in palliative care(Chair: Prof Pang Weng Sun)

Chronic Breathlessness: an Evidence-Based Update(Prof. David Currow)

Oral Presentation

10.00 - 11.00

Welcome Dinner / Cultural Night

Sponsored Lunch Symposium - PT. Mahakam Beta Pharma

Concurrent Sessions 3

Patient and Family Education in Palliative Care : The Role of Nurse

(Ms. Kemala Rita)

Updates on the management of neuropathic pain in cancer patients

(Dr. Hiromichi Matsuoka)

Satellite Symposium 6 --> Infection

Antibiotic Therapy for Hospital Aquired Pneumonia (Dr. Shinichiro Morioka)

Sepsis in patients with weeks of life expectancy (Dr. Shinichiro Morioka)

Recent Progress and Future Perspectives in APHN and Palliative Care in the Region

Sri Lanka, Bangladesh, Myanmar, India? Bhutan?

Dr. Cynthia Goh or Dr. Akhilesh to chair and nominate speakers

(Jim Cleary)

Special Need in Palliative Care

Saturday, August 3rd 2019

8





TIME

08.00 - 09.00

09.00 - 09.30


12.00 - 13.00

13.00 – 13.10

13.10 – 13.30

13.30 – 13.45

13.45 – 14.00

14.00 – 14.15

14.15 – 14.30

Sposored Lunch Symposium

PLENARY 5

13.00 - 14.30

Spiritual Aspect in Palliative Care Pediatric Palliative Care

Closing ceremony (Room 1 Grand City)

Opening

Report Chairman APHC 2019 (Dradjat R.Suardi, MD, FICS)

Perform from next host: Japan

Champion Announcement

DOORPRIZE

Closing

EVENTS

Meet the Expert


11.00 - 12.00

Singapore (Dr. Sumytra Menon:OK)Hong Kong (Dr. Annie Kwok: OK)Taiwan (Dr. Shao-Yi Cheng: OK)

Korea (Lisa : Dr. Sun-hyun Kim: OK)Japan (Prof. Kizawa--> Dr. Sayaka Takenouchi:

OK)Netherland (Judith-->Dr. Diah Martina: OK)

09.30 - 11.00

Concurrent Sessions

End of Life Discussion and Advance Care Planning in Asia and Pacific : Scope,

Challenges, and Opportunities( Chair: Prof. Josephine Clayton)

Advance Care PlanningProf. Marie Bakitas (University of Alabama)

Spiritual Aspect in Palliative Care(dr. Urip Murtedjo,Sp.BKL(K), FINACS(K),

FICS.,PGD.Pall.Med(ECU))

Emergency in Pediatric Palliative Care (Dr. Edi Setiawan Tehuteru, SpA(K)

Ethical Issues in Palliative Care(Prof W. F Maramis SpKJ (K))

Neonatal Palliative Care: Experiene in Setting up in Asian Region

(Dr. Chakra Vasuvedan--> or tentatives speaker from APHC)

Core Competence of Spiritual Care(Dr. Agus Ali Fauzi, PGD.Pall.Med (ECU)

Psychosocial Aspect in Neonatal Palliative Care

(Dr. Chakra Vasuvedan--> or tentatives speaker from APHC))

Sunday, August 4th 2019





10




Abstract Submission Guidelines

General Guidelines• We do not accept any work that has been published. • All abstracts have to be submitted in ENGLISH .• Abstracts will be evaluated based on their scientific content and novelty, and meritorious abstracts will be selected for oral presentation. All other shortlisted abstracts will be scheduled for poster presentation. Any abstract containing statements, symbols or other contact that are subjective and unscientific in nature will be rejected.

Abstract Submission Topics • Clinical Ethics• Pain and Symptom Management • Palliative Care in Non-cancer• Ageing and Geriatrics• Paediatric Palliative Care • Bereavement, Grief and Loss • Spirituality and Psychological health • Arts and Humanities (including art and music therapy) • Policy or Programme Advocacy, Development and Evaluation • Professional Issues and the Professional Worker • Education, Training and Supervision • Advance Care Planning and Communication • Rehabilitation and Clinical Nutrition • Family Care-givers• Self-Care and Wellness• Complementary Therapies /Natural Anal gesics




Abstract Submission GuidelinesRegistration and Expenses All presenting authors must be registered for APHC. Authors who have not paid their registration fees will not be allowed to enter. All expenses associated with the submission and presentation of the abstract are the sole responsibility of the presenter. ABSTRACT CONTENT PREPARATION Language Abstracts must be written and presented in English. Careful typing and proofreading is essential. The accepted abstract will be published as submitted. Once the abstract is submitted, changes, corrections or rewording will not be possible.

The Scientific Committee reserves the right to reject abstracts which are presented in poor English or to request an immediate revision.

Word CountThe maximum content of the abstract is limited to 3,000 characters (including title, body, spaces, tables and graphics). Each picture counts as 500 characters.

Topic Selection Please choose the most appropriate topic from the drop down menu.

Title The title should clearly define the topic of your research. Do not identify your institution in the title. There is no maximum length for the title. However, the characters in the title are included in your total character count. The first letter of any sentence in the title will automatically begin with a capital letter. Do not type the entire title in capital letters.

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Author(s)Type the full name of all authors. Omit any titles, degrees and institutional affiliations. It is advisable to check the correct spelling of the family name and initials of each author. If authors are from the same institution, the name of the institution must be written in the exact same way.

Affiliation Type the institution, Department, City and Country. if co-authors are from the same institution, the software will automatically copy all information into the subsequent boxes. You do not have to type the information again. if co-authors are not from the same institution, you can edit the boxes.

Abstract Content The following headings have been formatted for you and should NOT be entered in the text fields :1. Introduction & objectives2. Materials & methods3. Results4. ConclusionState the objective of the study, describe the material and methods and summarise the results of the research. You need to present sufficient details to support the conclusions reached. Please use standard abbreviations and generic drug names. Abbreviations should be spelled out, in parentheses, in the first use in the abstract. You can use the special keys to insert tables, pictures or specific characters Data Protection Policy All patient information should be de-identified. Patient’s faces should be blurred when used in images. Seek necessary permission from the copyright owner if copyrighted figures, images, or content are used in the abstract




Acknowledgements Do not include references, credits or grant support in your abstract.

Human Experimentation Any human experimentation conducted as part of the submitted abstract(s) must follow the protocol approved by the institutional or local committee on ethics in human investigation; or, if no such committee exists, the investigation should have been conducted in accordance with the principles of the World Medical Association’s Helsinki Declaration. Data Presentation Abstracts that describe investigations of compounds that involve inadequate numbers of study subjects, or abstracts that lack quantitative data may not be accepted. Authors should not “split” data to create several abstracts. Abstracts containing same data submitted from the same institution (and/or individuals) describing the same study population may be disqualified. Abstracts without data will not be considered. Submission Deadline Deadline for abstract submission is March 31st, 2019. To avoid incidences where your abstract cannot be submitted due to technical difficulties, computer problems or other reasons, you are advised to submit your abstract early. Important Dates to Note• March 31st, 2019 - Abstract submission close• February to March - Notification of abstract acceptance (Please register first in order to enjoy the early bird rate. You may make payment upon receiving the notification email that your abstract is accepted)• July 10th, 2019 - Payment deadline


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Registration &Accommodation

REGISTRATION BY EMAIL To get a registration form can contact thesecretariat at +62 315018840, +62 315501089

ON SITE REGISTRATION Those who have not registered in advance mayregister at onsite registration desk. Cash payment only in Rupiah and USD will be accepted during on site registration. No refund will be made for on site registration fees.

REGISTRATION PAYMENTAll registration fees must be paid by bank transfer. Registrant should bear all bank charges. Please send copy of the transaction along with the registration to the Organizing Committee.

HOTEL POLICYDue to high demand on the hotel room at the time of congress, the congress secretariat strongly recommended early reservations.

ROOM RATE Hotel rooms at special congress rate are being held for the congress participants Room rates are in Dollar, per night and per room included breakfast for two persons. Reservations must be made through the congress secretariat toguarantee the indicated rate negotiates for the congress

HOTEL RESERVATION Hotel assignment will be made on a “FIRST COME FIRST SERVE BASIS”.

REGISTRATION AND ACCOMMODATION SECRETARIATINDONESIAN PALLIATIVE SOCIETY c/o Palliative Care Building Dr. Soetomo General Hospital Surabaya Jl. Mayjend Prof. Dr. Moestopo No. 6 - 8, Surabaya, Jawa Timur 60285 Phone : +62 315018840, +62 31 5501089 Fax : +62 31 5018840 Email : [email protected]

PAYMENT BY Bank CIMB Niaga CIMB Niaga Branch Surabaya Acc Name : Masyarakat Paliatif IndonesiaA/C : 800 - 15096 - 5700 Swift Code : BNIAIDJA




*Early bird registrasions have been extended until Sunday March, 31st 2019.abstract submissions have been extended until thursday February, 28th 2019.

Registration &Accommodation Fee

16




TourismMount Bromo Sunrise

Suramadu Bridge

Ijen Crater




:

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:

:

:

:

:

: Name:

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NO TYPE FEE FOR CONFERENCE DELEGATES FOR WORKSHOP ONLY

□ 1a Half Day (AM) □ 40 USD □ 100 USD

□ 1b Half Day (PM) □ 40 USD □ 100 USD

□ 2 Full Day □ 75 USD □ 200 USD

□ 3 Full Day □ 75 USD □ 200 USD





Early Bird Jan 1st - July 1st, 2019 Onsite

□ Doctors □ USD 600 □ USD 650 □ USD 700

□ Non - Doctors □ USD 500 □ USD 550 □ USD 600

□ Doctors □ USD 350 □ USD 400 □ USD 450

□ Non - Doctors □ USD 200 □ USD 250 □ USD 300

□ Paediatric Palliative Care

□ Mandarin Hospice Summit(* session conducted in Chinese)

□ Pain Management

□ Psychosocial, Spiritual Care and TherapeuticCommunication in Palliative Care for Carers,Volunteers and Caregivers(* Session conducted in Bahasa)

□ Wound and Stoma Care

Membership Number

Rate available ONLY to participants residing in countries listed as “Low” and “Lower middle

Country

Please Mark (√) on Workshop / Symposium you choose

Mailing Address

Zip Code

Mobile Phone

□ Integration and Standard of Palliative Care inClinical Oncology

WORKSHOP

PARTICIPANT (Kindly Completed)

□ Developed Countries

CANCELLATION AND REFUND POLICYWritten cancellation notice is required. Cancellation must be received before May 1st 2019 a 50% refund will be returned after congress ended. No refund will be allowed thereafter

□ Developing Countries

□ 1

□ 2

NO

Title

Full Name

Organization/Institution

Please quote the sender’s name on the bank transfer statementWhen transmitting, please make sure who send the money possibly by fax.

TOTAL

TOTAL

SYMPOSIUMREGISTRATION FEE

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PAYMENT BY SIGNATURE

*Note: All APHN Individual Members are entitled to a 100 USD discount off the above price. Please provide your full name and membership number to enjoy the discount.

Email

Sponsor

Mobile Phone

□ Comprehensive Assessment of Patients

□ Psychosocial, Spiritual Care and TherapeuticCommunication in Palliative Care for Doctorsand Health Practitioners(* Session conducted in Bahasa)

THIS FORM TOGETHER WITH THE REQUISITEMENT PAYMENT AND/OR DOCUMENTATION SHOULD BE EMAILED/FAXED TO: The Congress Secretariat: Phone: +62 315018840 +62 31 5501089 | Fax: +62 31 5018840

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Bank Name : CIMB Niaga Branch SurabayaAccount Number : 800 - 15096 - 5700

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Equivalent currency USD 1 = IDR 15.500

THE 13TH ASIA PACIFIC HOSPICE AND PALLIATIVE CARE CONFERENCE

GRAND CITY CONVEX SURABAYA, AUGUST 1st - 4th 2019

Registration Form

18




Accommodation Form

:

:

:

:

:

:

:

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: Name:

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NO ROOM TYPE RATE/NETT/NIGHT

□ 1 Classic USD 85

□ 2 Deluxe USD 105

□ 3 Deluxe USD 97

□ 4 Classic USD 116

□ 5 Deluxe USD 65

□ 6 Business Suite USD 40

□ 7 Deluxe USD 85

□ 8 Harris USD 42

CANCELLATION AND REFUND POLICYWritten cancellation notice is required. Cancellation must be received before May 1 st 2019 a 50% refund will be returned after congress ended. No refund will be allowed thereafter

Majapahit Hotel (� 5)

Email

Sponsor

Mobile Phone

Title

Harris Hotel & Conven�ons Gubeng (� 4)

Sheraton Surabaya Hotel & Towers (� 5)

JW Marrio� Hotel Surabaya (� 5)

TH

THE 13TH ASIA PACIFIC HOSPICE AND PALLIATIVE CARE CONFERENCE

GRAND CITY CONVEX SURABAYA, AUGUST 1st - 4th 2019

TOTAL

: □ Prof □ Dr □ dr □ Specialist □ Other

Four Points By Sheraton Surabaya (� 4)

Surabaya Suites Hotel (� 4)

PARTICIPANT (Kindly Completed)

: BNIAIDJA

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Bank Name : CIMB Niaga Branch Surabaya

Account Number : 800 - 15096 - 5700

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THIS FORM TOGETHER WITH THE REQUISITEMENT PAYMENT AND/OR DOCUMENTATION SHOULD BE EMAILED/FAXED TO: The Congress Secretariat: Phone: +62 31 5018840, +62 31 5501089 | Fax: +62 31 5018840

Email: [email protected]

Please quote the sender’s name on the bank transfer statementWhen transmitting, please make sure who send the money possibly by fax.

Bumi Surabaya City Resort (� 5)

Wyndham Surabaya (� 5)

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HOTEL

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SecretariatINDONESIAN PALLIATIVE SOCIETYc/o Palliative Care BuildingDr. Soetomo General Hospital SurabayaJl. Mayjend Prof. Dr. Moestopo No. 6 - 8, Surabaya, Jawa Timur 60285 Phone : +62 31 5018840, +62 31 5501089Fax : +62 31 5018840 Email : [email protected]

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