PCSI School - Advanced Design and Implementation of Case-Mix Funding Models
April 13 – 17, 2015
Lisbon, Portugal

Application Form

After you have completed this application form, please email it to school director Jeff Hatcher at jhatcher@cihi.ca 

PCSI collects and uses your personal information to determine eligibility for admission, and to process your registration and maintain communication with you regarding the School. PCSI will not disclose, give or sell your personal information to third parties.
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Professional Degrees, Diplomas, and Certificates
	Educational Institution	Title of Degree, Diploma, or Certificate	Year of Completion	
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Please rate your level of experience in the following areas. Your answers to these questions will help us evaluate your application: 
Area	Knowledge Rating	
Diagnosis or procedure classification systems (e.g. ICD-9/10)		
Case-mix systems (DRG, Nord-DRG, HRG, etc)		
Case weight calculation		
Healthcare financial information and patient-level costing		
Case-mix funding		
Statistical concepts and inference (expectations,, distributions, p-values)		
Statistical modeling (e.g. linear regression)		
Statistical software (e.g. SPSS, SAS, STATA)		
Ability to work and study in the English language		

Please describe in 100 words or less, your current and past professional involvement in case- mix classifications and hospital payment systems.
     	

Please describe in 100 words or less, why you want to attend the School and how it will contribute to your professional development.