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[]
[]
[]
[]
[]
[]
[null,"Reason for Interest"]
[]
[null,"Reason for interest in SP work (brief description)",null,null,""]
[]
[]
[]
[]
[]
[]
[]
[null,"Preferred Roles / Involvement",null,null,""]
[]
[]
[]
[]
[]
[]
[]
[]
[null,"Physical Examination"]
[]
[null,"Willing to take part in physical examinations?",null,null,""]
[]
[null,"Elaboration if specified",null,null,""]
[]
[]
[]
[]
[]
[]
[]
[]
[null,"Engagement Source"]
[]
[null,"Where did the SP learn about the SP programme?",null,null,""]
[]
[]
[null,"Rating"]
[]
[null,"Rating Source",null,null,null,null,"Rating (1-10)"]
[null,""]
[null,""]
[null,""]
[null,""]
[null,""]
[null,""]
[null,""]
[null,""]
[null,""]
[null,""]
[null,"Role Suitability",null,null,""]
[]
[]
[]
[]
[]
[]
[]
[null,"Additional Comments",null,null,""]

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{"sheet":"Gallery","index":7,"n_rows":0,"n_cols":0,"rows_kept":0,"cut":false,"hidden":true,"merged":[]}

{"sheet":"Password","index":8,"n_rows":6,"n_cols":1,"rows_kept":6,"cut":false,"hidden":true,"merged":[]}
["f865b53623b121fd34ee5426c792e5c33af8c227"]
[]
[]
[]
[]
["Manchester Metropolitan University"]

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[null,null,null,null," "]
[null,"Your Details for the Simulated Patient Database"]
[]
[]
[null,"Data Protection"]
[]
[null,{"$f":"\"By completing this form, I give permission for my data to be held in the SP database of \" & txtOrganisationName & \" and agree that \" & txtOrganisationName & \" may process personal data relating to me for personnel, administration and / or management purposes, make such data available to \" & txtOrganisationName & \", and as required by law.\" & CHAR(10) & CHAR(10) & \"We will not make your contact details available to the public or external organisation in print or online.\"","v":"By completing this form, I give permission for my data to be held in the SP database of Manchester Metropolitan University and agree that Manchester Metropolitan University may process personal data relating to me for personnel, administration and / or management purposes, make such data available to Manchester Metropolitan University, and as required by law.\n\nWe will not make your contact details available to the public or external organisation in print or online."},null,null,null,null,"Signed"]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"Date"]
[]
[]
[]
[null,"Personal Particulars"]
[]
[null,"First Name(s)",null,null,""]
[null,"Surname",null,null,""]
[null,"Preferred Name",null,null,""]
[null,"Gender",null,null,""]
[null,"Ethnicity",null,null,""]
[null,"Nationality",null,null,""]
[null,"Country of Birth",null,null,""]
[null,"Date of Birth"]
[null,"Home Address\n(press ALT+Return for a new line in the field)",null,null,""]
[]
[]
[null,"Home Phone Number",null,null,""]
[null,"Mobile Phone Number",null,null,""]
[null,"Email Address",null,null,""]
[null,null,null,null,"(Emergency Contact must be a parent if SP aged < 16)"]
[null,"Emergency Contact Name",null,null,""]
[null,"Emergency Contact Phone (Home)",null,null,""]
[null,{"$f":"IF(IsChild,\"Parent\", \"Emergency\") & \" Contact Phone (Mob.)\"","v":"Emergency Contact Phone (Mob.)"},null,null,""]
[null,{"$f":"IF(IsChild,\"Parent\", \"Emergency\") & \" Contact Email\"","v":"Emergency Contact Email"},null,null,""]
[null,{"$f":"IF(IsChild,\"Parent\", \"Emergency\") & \" Contact Address\"","v":"Emergency Contact Address"},null,null,""]
[null,"Parental Consent\n(If Applicable)"]
[]
[null,"Photos"]
[]
[null,"Please provide two photos for use in the database."]
[]
[]
[null,"Physical Characteristics"]
[]
[null,"Scars, piercings, tattoos, or other physical characterictics.\n(press ALT+Return for a new paragraph in the field)",null,null,""]
[]
[]
[]
[]
[]
[]
[]
[null,"Weight (kg)"]
[null,"Height (cm)"]
[null,"Role Playing Age (Minimum)"]
[null,"Role Playing Age (Maximum)"]
[]
[null,"Language Proficiency"]
[]
[null,"Spoken Languages"]
[]
[null,"Language",null,null,null,null,"Proficiency"]
[null,"",null,null,null,null,""]
[null,"",null,null,null,null,""]
[null,"",null,null,null,null,""]
[]
[null,"Other Spoken Languages",null,null,""]
[]
[]
[]
[null,"Written Languages"]
[]
[null,"Language",null,null,null,null,"Proficiency"]
[null,"",null,null,null,null,""]
[null,"",null,null,null,null,""]
[null,"",null,null,null,null,""]
[]
[null,"Other Written Languages",null,null,""]
[]
[]
[]
[null,"Relevant Medical History"]
[]
[null,"Current / past medical conditions relevant to work as an SP",null,null,""]
[]
[]
[]
[]
[]
[]
[]
[]
[null,"Relevant Experience"]
[]
[null,"Relevant experience in acting / role play / SP work",null,null,""]
[]
[]
[]
[]
[]
[]
[]
[]
[null,"Relevant Skills"]
[]
[null,"Other relevant skills (e.g. teaching / sign language, etc.)",null,null,""]
[]
[]
[]
[]
[]
[]
[]
[]
[null,"Reason for Interest"]
[]
[null,"Reason for interest in SP work (brief description)",null,null,""]
[]
[]
[]
[]
[]
[]
[]
[null,"Preferred Roles or Involvement",null,null,""]
[]
[]
[]
[]
[]
[]
[]
[]
[null,"Physical Examination"]
[]
[null,"Willing to take part in physical examinations?",null,null,""]
[]
[null,"Elaboration if specified",null,null,""]
[]
[]
[]
[]
[]
[]
[]
[]
[null,"Engagement Source"]
[]
[null,"Where did you learn about the SP programme?",null,null,""]