Cover Sheet

Please ensure that all details on this page are completed.

Title / Name
Postal Address
Suburb / State / Postcode
Phone / Fax
E-mail
Signature

Please indicate which Clinical / Consumer Reference Group (CRG) you are applying for on the application form. If applying for more than one CRG, a separate application must be completed for each group.

Where do I send my application?

Please e-mail your application to at the

If you are not able to e-mail your application you can mail or fax a hard copy to:

Patient Blood Management Guideline Development

Blood Sector Clinical Development

National Blood Authority

Locked Bag 8430
CANBERRA ACT 2601

Fax: (02) 6103 3889

What is the closing date?

Applications close at the time and date specified on the NBA website.

Please use the following checklist to ensure your application is complete:

Cover Sheet (signed),

Application form, and

Selection Criteria.

Application Form

Name of CRG you are interested in (please tick): / Module 6 – Paediatrics / Neonates
Please tell us why you are interested in joining this CRG and what are you hope to gain from the experience?
Have you, or someone you care for, had blood or blood products or faced the decision to receive a blood transfusion?
What support will you need from the NBA in order to attend and participate in CRG meetings?

Selection Criteria

Essential
Over 16 years of age Yes No
Have used health care services relating to paediatrics / neonates (children or babies) or are capable of representing the users of these services.
Be able to articulate the potential issues that confront patients, families and carers who receive services from paediatric areas.
Be able to work constructively with fellow CRG members, systematic reviewers and NBA staff.
Available to attend two-day interstate meetings every six to eight weeks.
Yes No
Desirable
An established link with health consumer or community group.
Yes No
If yes, please give details:
Understanding of the Australian Healthcare setting and research processes such as reviewing medical literature. (Note: basic training will be provided)
An interest in the use of blood and blood products.

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