Simulation Center Billing and Scheduling:

PLEASE FILL IN ALL REQUIRED FIELDS

*Date and Duration of Session
Contact Info:
 
*Name of person requesting reservation
Name of faculty member
*Phone number
*E-mail address
(*Required Fields)  
Department Affliation
Primary User Group:
(Faculty/Student/Resident/Fellow)
Number of Users

Type of Session/Skill Level of Users:

Faculty-led instruction
       (Students with trained faculty/instructor).
       Faculty has to be present

Independent Practice
       (for those who have used facilities or have        completed a training session in advance).
KeyCard Access into SimCenter:
Yes   No

Equipment Required

Hystero Trainer
Lap SIM
Lap Mentor
Uro Mentor
Endoscopy Simulator
Video MAC
StandAlone Box Trainers
Human Patient Simulator**
PediaSIM**
SimMAN
Birthing Simulator (Noelle) and Baby HAL
Code Blue Baby
GeoWall Projection System
GE Anesthesia Machine
Audio Visual Equipment/Overhead LCD
Vascular Interventional Simulator
Trauma Man

**We however have only one driving rack, so either the PED or the ADULT can be used at a time.

Support Required:

Technical supervision
Instructional support/development
Additional room

Additional Setup and Miscellaneous:
(Tables and chairs, early set-up, user bringing other equipment)