Contraceptive Implant Train the Trainer Program Application Form

Home > Contraceptive Implant Train the Trainer Program Application Form
Home > Contraceptive Implant Train the Trainer Program Application Form

Complete the following form to express interest in SHINE SA’s Contraceptive Implant (Implanon NXT) Train the Trainer Program.

Contraceptive Implant Insertion Train The Trainer Application

"*" indicates required fields

Name*
Email address*
Do you have Professional Indemnity Insurance?*
It is a pre-requisite of enrolment that you have Professional Indemnity Insurance that covers you for this training.
Do you hold a current Implanon NXT theory and simulation training certificate/statement of attendance?*
Max. file size: 50 MB.
Are you registered with the manufacturer as an Implanon NXT inserter/remover to receive relevant clinical updates to PI?*
Do you have at least 12 months clinical experience with insertion and removal of Implanon NXT?*
Do you agree to teach the standard Implanon NXT insertion and removal technique and comply with national training standards?*
Do you agree to provide evidence of training (e.g. Certificate/statement of attendance) to your trainees who attend/complete training?*
Do you agree to maintain clinical competency as a trainer via: (A) Provision of at least 1 Implanon NXT training session per year, (B) Maintenance of knowledge, clinical practice and professional development in contraceptive practice and implants?*
If you are successful in becoming a credentialed trainer, do you consent for your name to be added to Organon and SHINE SA’s website as an Implanon NXT Trainer?*
Note: Eligibility for this program is at the discretion of the Coordinator of Medical Education and/or LARC Coordinator.
This field is for validation purposes and should be left unchanged.

SHINE SA Hyde Street Practice57 Hyde Street, AdelaideSHINE SA Woodville64c Woodville Road, Woodville SA 5011, Australia
8300 5300
info@shinesa.org.au

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