To Bringing Hope Those in Despair - THE 13 ASIA PACIFIC HOSPICE AND PALLIATIVE CARE CONFERENCE - APHC 2019

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To Bringing Hope Those in Despair - THE 13 ASIA PACIFIC HOSPICE AND PALLIATIVE CARE CONFERENCE - APHC 2019
THE 13th ASIA PACIFIC HOSPICE
AND PALLIATIVE CARE CONFERENCE
             SECOND ANNOUNCEMENT

   Bringing Hope
              to
  Those in Despair
               st   th
To Bringing Hope Those in Despair - THE 13 ASIA PACIFIC HOSPICE AND PALLIATIVE CARE CONFERENCE - APHC 2019
APHC 2019
 13th ASIA PACIFIC HOSPICE CONFERENCE

 SURABAYA - INDONESIA

Table of Content

Greeting											2
About APHC 2019								3
Committee 										4
General Information 							5
Workshop										6
Symposium 										7
Abstract Submission Guidelines 				     10
Registration & Accommodation 				14
International Flight								15
Tourism 											17
Registration Form								18
Accommodation Form 							19
To Bringing Hope Those in Despair - THE 13 ASIA PACIFIC HOSPICE AND PALLIATIVE CARE CONFERENCE - APHC 2019
2                                                                                    APHC 2019
                                                                                      13th ASIA PACIFIC HOSPICE CONFERENCE

                                                                                      SURABAYA - INDONESIA

                                                                          Greeting

  On behalf of the APHC 2019 Organising Committee, we kindly invite you to attend the
  conference. This is the first APHC conducted in Indonesia and will be held in the city of
  Surabaya. Why in Surabaya? Surabaya is the place where palliative care organisations
  and services, as well as training has been conducted and are spreading to several cities in
  Indonesia.

  Palliative care is a relatively new field of medicine in Indonesia that is not yet widely known.
  We have to consider that every patient with life threatening diseases will need palliative
  care at the last phase of their life. Having the theme “Bringing Hope to Those in Despair”
  for APHC 2019, it is hoped that the problems and challenges associated with palliative care
  development in Indonesia and the region can be solved through sharing of expertise and
  experience by world renowned experts during this conference. We hope that by holding
  APHC in Indonesia, palliative care can be better known in our country, advancing palliative
  care developments and in turn result in the building of better, more professional services.

  The conference is co-organised by the Indonesian Palliative Society (MPI) and the Asia
  Pacific Hospice Palliative Care Network (APHN). It can be attended by general practitioners
  and specialists, nurses, pharmacists and other healthcare professional, medical and nursing
  students, and volunteers.

  The APHC 2019 and its related activities is Surabaya has supported by the Provincial
  Government of East Java, the Ministry of Health and the Ministry of Tourism. We are pleased
  to invite you to enjoy the beautiful sights and our unique culture, as well as to visit the
  medical, tourism, industrial exhibitions.

  Looking forward to your attendance and participation in APHC 2019 that will be held on 1st
  to 4th August 2019 at the Grand City Convention Center in Surabaya. Further information
  about the conference can be accessed through our official website at www.aphc2019.com

  See you at APHC 2019

  Dradjat R.Suardi, MD, FICS,
  Chairman, Organising Committee of APHC 2019

www.aphc2019.com                   The 13th Asia Pacific Hospice Conference, 2019, SURABAYA - INDONESIA
To Bringing Hope Those in Despair - THE 13 ASIA PACIFIC HOSPICE AND PALLIATIVE CARE CONFERENCE - APHC 2019
APHC 2019
    13th ASIA PACIFIC HOSPICE CONFERENCE

    SURABAYA - INDONESIA
                                                                                                        3
  About APHC 2019

  After the 12th APHC in Singapore in 2017, Indonesia – through The Indonesian Palliative
  Society (MPI) – has expressed their willingness to host The 13th Asia Pacific Hospice Palliative
  Care Conference 2019. Indonesia understands the importance of its role in the Asia Pacific
  region to participate in the update of science and knowledge on palliative care.

  As an initiator of palliative science and knowledge progress in Indonesia, Surabaya has
  been appointed as the next host in this biennial event. The local team has been utilising all
  existing resources and getting ready the facilities and infrastructure to meet the standards
  of a world class event. From event execution, safety and comfort of the participants, to
  supporting facilities such as tourist attractions, Surabaya is prepared to welcome The 13th
  Asia Pacific Hospice Palliative Care Conference 2019 participants.

  With the trust that has been given and the remaining time, Indonesia is optimistic that the 13th
  Asia Pacific Hospice Palliative Care Conference 2019 will go well and achieve the optimum
  result.

www.aphc2019.com                           The 13th Asia Pacific Hospice Conference, 2019, SURABAYA - INDONESIA
To Bringing Hope Those in Despair - THE 13 ASIA PACIFIC HOSPICE AND PALLIATIVE CARE CONFERENCE - APHC 2019
4                                                                                                                        APHC 2019
                                                                                                                           13th ASIA PACIFIC HOSPICE CONFERENCE

                                                                                                                           SURABAYA - INDONESIA

                                                  Committee
                                                        ORGANISING COMMITTEE
                                                   Chair : Dradjat R. Suardi, MD, FICS
                                          Chief Liaison : Ramaswamy Akhileswaran, MD-APHN
                                          Secretariat : L. I. Irmawati, Pharm. Clin. MHA. PGDHSc

                                                        SCIENTIFIC COMMITTEE
                                                   Chair : Yoshiyuki Kizawa, PhD-APHN
                                                    Co-Chair : Siti Anisa Nuhoni, MD

   Members of Scientific Committee : Masanori Mori, MD-APHN | Rudi Putranto, MD | W. Sudarsa, MD | Maria Witjaksono, MD | Johan
  Kurnianda, MD | Edi S. Tehuteru, MD | Agustina Konginan, MD | Wiwiek Indriyani, MD | Kemala Rita Wahidi, Ns | Christantie Effendy, Ns |
                                                        Navin Salins, MD-APHN

                                               POSTER & ABSTRACT SUB-COMMITTEE
                                                Chair : Marlina S. Mahajuddin, MD, PhD
                                   Co-Chair : Angela Bibiana Maria Tulaar, MD, PhD | Probosuseno, MD

    Member of Poster & Abstract Sub-Commitee : Tri Arimanto Y, MD | Sahudi, MD | Noorwati Sutandyo, MD | Herdy Sulistyono, MD |
   Tjokorda Dharmayuda, MD | Erni P. Kolopaking, Apt, MD | Laksmi Wulandari, MD | Martina Sinta Kristanti, Ns | Ulinta P. Pasaribu, MD |
                                               Ika Symsul Huda, MD | Amik Yuliati, MD

                                                           SOCIAL COMMITTEE
                                            Chair : Agus Ali Fauzi, dr., PGD. Pall. Med (ECU)
                                     Co-Chair : L. I. Irmawati Apt., Pharm. Clinc., MHA. PGDHSc (ECU)

  Member of Social Committee : Susi Ernawati, dr., PGD. Pall. Med. (ECU) | Budi Sulistiani Yulianto, dr., MKes. | Ira Yuniati, dr., SpRad. |
 Lizza Hendriadi, Drg | Ni Ketut Putri Ariani, dr. SpKJ | Diar Mia Ardani, dr., SpTHT-KL | Rugaiyah Adam, SST, M.Psi | Dra. M. Christine HK |
                                Rudi Prins | Sri Setyawati, Apt | DR. Rosida, S.TP, MP | Agustin Anggraini, Apt.

                                                         LOGISTIC COMMITTEE
                                                      Chair : Iwan Sulianto, dr. SpPD
                                                     Co-Chair : Agus Hidayat, dr., SpP

      Member of Logistic Committee : Jusak Ampulembang, dr | Wahju Maria Widowati, dr | Heri Purnomo, SE | Tresia Adalena, SST |
  Siti Guntarlin, SKM | Buntirto | Aryani G. Soegiharto | Mufid, S.Kep. Ns., MMKes | Subagyo, dr, SpKFR(K) | Djohan Ardiansyah, dr., SpS |
                                           Imanuel Eka Tanta Putra, dr | Happy Setiawan,SPsi, Mpsi

                                                   FUND RAISING SUB-COMMITTEE
                                              Chair : Adityawati Ganggaswari, dr, M.Biomed
                           Co-Chair : Prof. Boediwarsono, dr., Sp.PD., KHOM., PGD. Pall. Med (ECU)., FINASIM

 Member of Logistic Committee : Prof. Husni Tanra, dr., Sp.An-KIC,PhD | Urip Murtedjo, dr., SpB.KL(K). FINACS(K). FICS., PGD. Pall. Med
 (ECU) | Herdy Sulistyono, dr, SpAn. KIC. KMN. PGD. Pall. Med (ECU) | Drajat Ryanto Suardi, dr., Sp.B(K)Onk | DR. Sahudi, dr, SpBKL(K) |
 DR. Brahmana Askandar, dr., SpOG(K-Onk) | DR. Johan Kurnianda, dr., Sp.PD, KHOM | DR. Ferdiansyah, dr., SpOT(K) | Agus Ali Fauzi, dr.,
  PGD. Pall. Med (ECU) | Tjokorda Dharmayuda, dr., Sp.PD., KHOM | DR. I. Wayan Sudarsa, dr., Sp.B(K)Onk | DR. Noorwati Sutandyo, dr.,
              Sp.PD, KHOM | DR . Agus Turchan, dr., SpBS(K) FRSC | L. I. Irmawati Apt., Pharm. Clinc., MHA. PGDHSc (ECU)

                                                         STEERING COMMITTEE
                     Chair : Prof. R. Sunaryadi Tejawinata, dr., SpTHT-KL(K-Onk). FICS. FAAO. PGD. Pall. Med (ECU)
                                             Co-Chair : Prof. W. Suardana, dr., SpTHT-KL(K)

Member of Steering Committee : Prof. Boediwarsono, dr, SpPD. KHOM, PGD. Pall. Med (ECU). FINASIM | Prof. Marlina S. Mahajuddin, dr.,
 SpKJ(K). PGD. Pall. Med (ECU) | Urip Murtedjo, dr., SpB-KL(K).FINASCS (K). FICS. PGD. Pall. Med (ECU) | Prof. DR. Aru W. Sudoyo, dr.,
               SpPD. KHOM. FACP | Prof. Andi Fahruddin, dr., SpPD. KHOM | Prof. A. Husni Tanra, dr., SpAn.-KIC. PhD

    APHN representatives : Ghauri Aggarwal, A/PhD | Jan Philips, Ms | Patsy Yates, PhD | Jane Fischer, MD | Magaret O Connor, PhD |
 Odette Spruyt, MD | Anil Tandon, MD | Jane Philips, PhD | Dipti Mittal, MD | Rico Liu, MD | Inda Soong, MD | Lam Wai Man, MD | Amy Chow,
 A/PhD | Annie Kwok, MD | Sushma Bhatnagar, PhD | Hyun Sook Kim, PhD | Kwon So Hi, PhD | Liese Groot-Alberts, Mrs | Sue Marsden, MD
| Ross Drake, MD | Ong Wah Ying, MD | Edward Poon, A/PhD | Gilbert Fan, MD | Neo Han Yee, MD | Lalit Krishna, A/PhD | Chong Poh Heng,
  MD | Noreen Chan, MD | Jun Hua Lee, MD | Chun Kai Fang, MD | Srivieng Pairojkul, PhD | Tatsuya Morita, MD | Tatsuo Akechi, PhD | Jun
Hamano, MD | Ai Oishi , MD | Masanori Mori, MD | Sayaka Takenouchi, A/PhD | Nobuyuki Yotani, MD | Ryuichi Sekine, MD | Isseki Maeda, MD
      | Yoshihisa Matsumoto, MD | Keiko Tanaka, MD | Takashi Yamaguchi, MD | Iwao Osaka, MD | Akira Inoue, MD | Harue Arao, MD |
                                                            Megumi Kishino, Ms

                                                          FINANCE COMMITTEE
                           Chair : Andari Krisnani, Mak I Member of Finance Committee : Fan Kwan, Mr-APHN

                                                      FACULTY MEMBER
   Joanne LYNN, MD, MA, MS | David HUI, MD, MSc| Marie BAKITAS, MD, DNSc, NP-C, AOCN, ACHPN, FAAN | David CURROW, PhD |
                                                   Josephine CLAYTON, MD

www.aphc2019.com                                  The 13th Asia Pacific Hospice Conference, 2019, SURABAYA - INDONESIA
To Bringing Hope Those in Despair - THE 13 ASIA PACIFIC HOSPICE AND PALLIATIVE CARE CONFERENCE - APHC 2019
APHC 2019
    13th ASIA PACIFIC HOSPICE CONFERENCE

    SURABAYA - INDONESIA
                                                                                                           5
  General Information

  Event Place
  GRAND CITY CONVENTION & EXHIBITION

  Jalan Walikota Mustajab No.1, Ketabang, Genteng, Surabaya, Jawa Timur 60272 Indonesia

  Phone: (031) 5459000

  Event Schedule
  • SCIENTIFIC WORKSHOP

   August 1st 2019
  • SCIENTIFIC SYMPOSIUM

   August 2nd - 4th 2019

  • MEDICAL EXHIBITION

   August 2nd - 4th 2019

                                           INDONESIAN PALLIATIVE SOCIETY
                                           c/o Palliative Care Building
                                           Dr. Soetomo General Hospital Surabaya
                                           Jl. Mayjend Prof. Dr. Moestopo No. 6 - 8, Surabaya, Jawa Timur 60285
                                           Phone		       : +62 315018840, +62 31 5501089
                                           Fax		         : +62 31 5018840
                                           Email		       : aphc2019surabaya@gmail.com

www.aphc2019.com                              The 13th Asia Pacific Hospice Conference, 2019, SURABAYA - INDONESIA
6                                                                                                                                                                                                                        APHC 2019
                                                                                                                                                                                                                          13th ASIA PACIFIC HOSPICE CONFERENCE

                                                                                                                                                                                                                          SURABAYA - INDONESIA

                                                                      Pre Conference Workshop
                                                                                   APHC 2019
                                                                                         Thursday, August 1st 2019
    Time                             Room 1                                           Room 2                                     Room 3                                        Room 4                                             Room 5
 07.00 - 08.00                                                                                                                     Registration
                                   Workshop 1A                                     Workshop 2A                                 Workshop 3A                                    Workshop 4A                                       Workshop 5A

                                                                                                                                                                                                               Psychosocial, Spiritual Care and Therapeutic
                 Integration and Standard of Palliative Care in                                                     Mandarin Hospice Summit (Session
                                                                             Paediatric Palliative Care                                                                  Pain Management                             Communication in Palliative Care
                               Clinical Oncology                                                                         conducted in Chinese)
                                                                                                                                                                                                                   (For Cadres, Volunteers, Caregivers)

                                      The integration of oncology                                                                                                                  Pain Management in
                                                                                                                                                                                                                                    Overview in Palliative Care
                                       and palliative care (IOP):                                                                                                                Chronic Conditions versus
                  09.00 - 09.30                                                                                        opening. Prof. Cynthia Goh             09.00 - 09.30                                     08.00 – 09.00        (dr. Siti Annisa Nuhonni
                                         An evidence update             Neonatal Palliative CareSpeaker:                                                                           Palliative Care Setting
                                                                                                                                                                                                                                              SpKFR-K)
                                             (dr David Hui)                  - dr. Chakra Vasuvedan                                                                                (dr. Wiwiek Indriyani)
                                                                      - dr. Edi Setiawan Tehuteru, SpA(K),
                                         The current status of
                                                                                      MHA                                                                                           Understanding Pain
                                       palliative care in the Asia-         dr. Marry Ann Muckaden                                                                               Pathway in The Context of
                  09.30 - 09.50                                                                                                                               09.30 - 10.00                                     09.00 – 09.10               Discussion
                                              Pacific region                                                                                                                      Total Pain (International
                                        (dr. Takashi Yamaguchi)                                                                                                                           speaker)
                                                                                                                  Regional Differences in Cultural, and
                                                                                                                  Life & Death Perspectives of Hospice                                                                             Family Support in Palliative
                                                                                                                                                                                 Assessment of chronic and
                                                                                                                 Palliative Care for the Ethnic Chinese.                                                                                      Care
                  09.50 - 10.05               Coffee Break                                                                                                    10.00 - 10.30             cancer pain             09.10 – 10.10
                                                                                                                 Speaker: Prof. Liu Duan Qi, Prof. Chun-                                                                             (dr. Agustina Konginan
                                                                                                                                                                                     (Prof Husni Tanra)
                                                                                                                          Kai Fang, 邀請中(TBA)                                                                                                  SpKJ)
                                                                                                                        (Hong Kong), 邀請中(TBA)
                                                                                                                                (Singapore)                   10.30 -10.45              Coffee Break            10.10 – 10.20               Discussion
                                        Scope, challenges, and
                  10.05 - 12.05         opportunities of IOP in                                                                                                                            Pain
                                           Asian countries                                                                                                                       pharmacotherapeutics as
                                                                                                                                                              10.45 - 11.15                                     10.20 – 10.30              Coffee Break
                                                                                                                                                                                 applied to palliative care
                                                                                                                                                                                    (Dr Naveen Salim)

                                           How to overcome
                                                                                                                                                                                    Rationale analgesic
                                       challenges and implement
                                                                                                                                                                                  prescribing in palliative                        Grief and Bereavement (dr.
                  12.05 - 12.30          IOP in Asian countries:                                                                                              11.15 - 11.45                                     10.30 – 11.30
                                                                                                                  Exploring the philosophy of Hospice                                       care                                   T. Arimanto Yuwana, SpKJ)
                                            Future directions
                                                                                                                 Paliative Care Speaker: Prof. Liu Duan                           (International speaker)
                                            (Panel Discussion)
                                                                                                                 Qi, Prof. Chun-Kai Fang, 邀請中(TBA)
                                                                                                                       (Hong Kong), 邀請中(TBA)                                        Interventional pain
                                                                                                                               (Singapore)                                       management in palliative
                                                                                                                                                              11.45 - 12.15      care setting (International    11.30 – 11.40               Discussion
                                                                                                                                                                                          speaker)
                                                                                                                                                                                        (Dr. Sushma)

                                                                                                                                                                                                                11.40 - 12.15            Case Discussion
                                                                                                                                      Lunch
                                   Workshop 1B                                     Workshop 2B                                 Workshop 3B                                    Workshop 4B                                       Workshop 5B
                                                                                                                                                                                                               Psychosocial, Spiritual Care and Therapeutic
                    Comprehensive Assessment of Patient                 Paediatric Palliative Care (continue)      Mandarin Hospice Summit (Continue)                 Wound and Stoma Care                          Communication in Palliative Care
                                                                                                                                                                                                                         (for Doctors and Nurses)
                                                                                                                  sharing of findings and experiences:                           The Challenge Of Chronic                            Psychosocial Aspect in
                   13.00 - 14.00             Breathlesness                                                                                                    13.30-14.15          Wound Management             13.00 – 14.00             Palliative Care
                                                                           Neonatal Palliative CareSpeaker:          speaker (Haidian Beijing, putuo
                                                                                                                                                                                   (Helen SKep, Ns ETN)                               (dr Maria Witjaksono,
                                                                                 - dr. Chakra Vasuvedan            shanghai, deyang sichuan, luoyang
                                                                                                                                                                                 Colostomy Management In
                                                                      - dr. Edi Setiawan Tehuteru, SpA(K), MHA      henan, changcun jilin, 印尼華人,                                                                                         The Last 48 Hours
                                                                                                                                                                                        Palliative Care
                   14.00 - 15.00            Pain Asessment                      dr. Marry Ann Muckaden            chinese in indonesia, 馬來西亞華人,               14.15-15.00                                       14.00 – 15.00       (dr Erikavitri Yuwana SpKJ-
                                                                                                                                                                                  (Ria Anjarwaty SKep, Ns.,
                                                                                                                          chinese in malaysia)                                                                                                    K)
                                                                                                                                                                                             ETN)

                   15.00 - 15.15              Coffee Break                                                                       Tea Break                    15.00 - 15.15             Coffee Break            15.00 – 15.15              Coffee Break

                                                                                                                          Round table Discussion:                                                                                    Medicolegal in Palliative
                                                                                                                                                                                 Dry workshop wound and
                   15.15 - 16.15                 Dementia                                                        Collaboration for the Ethnic Chinese under   15.15-16.15                                       15.15 – 16.15                 Care
                                                                                                                                                                                      stoma stage 1
                                                                                                                    the APHN Structure. Summit speaker                                                                                   (Prof. Marlina)
                                          Neurodegenerative                                                       Closing Remarks : speaker Prof. Cynthia                        Dry workshop wound and
                   16.15 - 17.15                                                                                                                              16.15-17.15                                       16.15 - 17.15            Case Discussion
                                              Disorders                                                                            Goh                                                stoma stage 2

www.aphc2019.com                                                                         The 13th Asia Pacific Hospice Conference, 2019, SURABAYA - INDONESIA
APHC 2019
   13th ASIA PACIFIC HOSPICE CONFERENCE

   SURABAYA - INDONESIA
                                                                                                                                                                                                            7
  THE 13th ASIA PACIFIC HOSPICE
  PALLIATIVE CARE CONFERENCE 2019
                                                                                  Friday, August 2nd 2019
                                             TIME                                                                          EVENTS

                                          07.30 - 08.30                                                                   Registration

                                                                                                                      Opening Ceremony

                                                                         08.30 - 08.35                                                                Opening

                                                                         08.35 - 08.50                                         Angklung Music Performance by Cancer Patient

                                                                                                                                                 Opening Speech
                                                                         08.50 -08.55
                                                                                                                                            (Dradjat R.Suardi, MD, FICS)
                                                                                                                                          Welcome Speech for participant
                                                                         08.55 -09.10
                                          08.30 – 10.00                                                                                  (Major of Surabaya Palliative City)

                                                                                                                                                Keynote Speech
                                                                         09.10 - 09.30                                    "The Challenge of Palliative Care In Modern Technology Era"
                                                                                                            ( Prof. R. Sunaryadi Tejawinata,dr., SpTHT-KL(K-Onk). FICS. FAAO. PGD.Pall.Med (ECU))

                                                                                                                                                  APHN Speech
                                                                         09.30 - 09.40
                                                                                                                                               (Prof. Chynthia Goh)
                                                                                                                                                  Formal Speech
                                                                         09.40 - 09.50
                                                                                                                                         (Minister of Health of Indonesia)
                                                                                                                                        Award for dr.ROSALIE SHAW
                                                                         09.50 - 10.00
                                                                                                                     (Urip Murtedjo,dr.,SpB-KL(K).FINASCS (K). FICS. PGD.Pall.Med (ECU))
                                                                                                                          PLENARY 1
                                          10.00 - 11.00                                  Bringing Hope to Those in Despair: Communication in Advance Care Planning
                                                                                          (Prof. Josephine Clayton (The University of Sydney- Sydney Medical School)
                                                                                                                          PLENARY 2
                                          11.00 - 12.00                                  The Best Palliative Care in The Last 3 Days of Life: an Evidence-Based Update
                                                                                                                         (Dr. David Hui)

                                          12.00 - 13.30            Lounge and Friday Prayer                     APHN Annual General Meeting                Coffee Break, Exhibition, and Poster Viewing

                                                                                                         Sponsored Lunch Symposium - Mundi Pharma
                                          13.30 - 14.30
                                                                                                        The use of oxocodon in cancer pain management

                                                                                                                     3 Concurrent Sessions

                                                                      Scientific Session 1                           Educational Session 1                                Scientific Session 2

                                                          Cancer Pain Management : How to Make the                                                          Relief from Agitated Delirium at The End of
                                          14.30 - 15.30                                                            Symptoms Management
                                                                Most of Inexpensive Analgesics                                                                                  Life

                                                                                                                                                                  How can we maximize the use of
                                                                                                                      Nausea And Vomitus
                                                                                                                                                                          antipsychotics?
                                                                  Morphine and Methadone                      (dr. Johan Kurnianda, SpPD, KHOM)
                                                                                                                                                                        (Prof. Meera Agar)
                                                                     (dr. Suresh Reddy)
                                                                                                                    Anoreksia and Cacchexia                     What is the role of benzodiazepines?
                                                                                                             (dr. Noorwati Sutandyo, SpPD, KHOM)                           (Dr. David Hui)

                                          15.30 - 15.45                                                  Coffee Break, Exhibition, and Poster Viewing

                                                          Satellite Symposium 1--> Heart Failure and                                                                  Satellite Symposium 3
                                          15.45 - 16.35                                                       Satellite Symposium 2--> Dementia
                                                                        Palliative Care                                                                         Management of diabetic kidney failure

                                                                                                                                                            Shared decision making in the appropriate
                                                           How is Heart Failure Different from cancer
                                          15.45 - 16.05                                                       Psychiatric and behavioral problems            Initiation of and withdrawal from dialysis
                                                                         (Dr. Bakitas )
                                                                                                                                                                             (Dr. Miura)

                                                           Standard and symptomatic treatment for
                                                                                                                                                            Palliative And End of Life Care For People
                                          16.05 - 16.25             palliative heart failure                  Caregiving of patient with dementia
                                                                                                                                                            With Diabetes : Clinical Practice (Dr. Miura)
                                                                          (Dr. Bakitas)

                                          16.25 - 16.35                      Q&A                                             Q&A                                                Q&A

                                                                                                                      Concurrent Session

                                                                      Scientific Session 1                           Educational Session 1                                Scientific Session 2

                                          16.35 - 17.35                                                                                                            What is the best practice in non-
                                                                                                                             Fatique
                                                                                                                                                                       pharmacological care
                                                          Sustainable, effective pain management in a       (Prof. Karin Van Der Rijt (Erasmus Univ))
                                                                                                                                                                      (Dr. Sayaka Takenouchi)
                                                                         hospital setting
                                                                   (Dr. Sushma BHATNAGAR)                                                                       Best practices in palliative sedation &
                                                                                                                 Nutrition Disorders Problems
                                                                                                                                                                          refractory distress
                                                                                                              (dr. Fiastuti Witjaksono, M.S., SpGK)
                                                                                                                                                                       (Dr. Takashi Yamaguchi)

                                                                                                          Faculty Dinner (Mojopahit Hotel) 100 person

                                                                         18.00- 18.05                                                                 Opening

                                                                                                                                         Speech of Chairman APHC 2019
                                                                         18.05 - 19.25
                                                                                                                                           (Dradjat R.Suardi, MD, FICS)

                                                                         19.25 - 19.40                                                          Speech from APHN
                                          18.00 - 21.40
                                                                                                                                            Dinner and Entertainment

                                                                         19.40 - 21.30                                                       Palliative Volunteer Choir

                                                                                                                                                        Music

                                                                         21.30 – 21.40                                                             Closing by MC

www.aphc2019.com                                                           The 13th Asia Pacific Hospice Conference, 2019, SURABAYA - INDONESIA
8                                                                                                                                                                                                                              APHC 2019
                                                                                                                                                                                                                                13th ASIA PACIFIC HOSPICE CONFERENCE

                                                                                                                                                                                                                                SURABAYA - INDONESIA

                                             THE 13th ASIA PACIFIC HOSPICE
                                       PALLIATIVE CARE CONFERENCE 2019
                                                       Saturday, August 3rd 2019
             TIME                                                                                    EVENTS
                                                                                                Meet the expert
          08.00 - 09.00
                                                                                   (Plenary Speakers + Other Regional Experts)
                                                                                                    PLENARY 3
          09.00 - 10.00                                                        Chronic Breathlessness: an Evidence-Based Update
                                                                                              (Prof. David Currow)
                                                                                                    PLENARY 4
          10.00 - 11.00                                                                    Hinohara Memorial lecture
                                                                                               (Dr. Joanne Lynn)

          11.00 - 11.15                                                           Coffee Break, Exhibition, and Poster Viewing

                                                                                               Concurrent Sessions

                                       Scientific Session 3                             Educational Session 2                                    Scientific Session 4

                                                                                                                                    Room are divided into : Oral presentation

                           Essential leadership skills in palliative care
                                                                                   Special Need in Palliative Care
                                  (Chair: Prof Pang Weng Sun)
                                                                                                                                                                                         P
                                                                                                                                                                                         r
          11.15 - 12.15                                                                                                                                                                  e
                                                                               Symptoms of Advanced Chronic Kidney                                                                       s
                                                                                     Disease in Palliative Care                                                                  O       e
                                                                                                                             Pain management in non-cancer condition             r       n
                               Dr. Cynthia Goh /Dr. Ednin Hamzah                         (dr. Frank Brennan)                            (Dr. Joanne Lyn)                         a       t
                                          Dr. Jim Cleary                                                                                                                         l       a
                                       Prof. David Currow                                                                                                                                t
                                      Prof. Yoshiyuki Kizawa                    Screening and Expert Management in                                                                       i
                                     Prof. Tamura (nursing)                 HIV/AIDS Associated with Significant Level of                                                                o
                                                                                Physical and Psychological Symptoms                                                                      n
                                                                              (Prof. Dr. dr Syamsurizal Djauzi, SpPD-KAI)

          12.15 - 13.30                                                     Sponsored Lunch Symposium - PT. Mahakam Beta Pharma

                                                                                              Concurrent Sessions 3

                                    Scientific Session 3 :                                                                                                                        O
                                                                                        Educational Session 2                             Scientific Session 4
                           Updates of major topics in palliative care                                                                                                             r
          13.30 - 14.00                                                                                                                                                           a
                                                                                        Nurse Paliative Care                                                                      l
                          Updates on the management of neuropathic
                                    pain in cancer patients                    Improving Palliative Care Using Quality                                                               P
                                   (Dr. Hiromichi Matsuoka)                       Indicators: Nurses’ Perspective                                                                    r
                                                                                        (dr. Maho Aoyama)                    Recent Progress and Future Perspectives in              e
                                                                                                                               APHN and Palliative Care in the Region
                                                                                                                                                                                     s
                                          Prognostication                                                                     Sri Lanka, Bangladesh, Myanmar, India?
                                                                              Patient and Family Education in Palliative                                                             e
                            (part 2: How to communicate prognosis +                                                                           Bhutan?
          14.00 - 14.30                                                                Care : The Role of Nurse                                                                      n
                                     future research direction)                                                              Dr. Cynthia Goh or Dr. Akhilesh to chair and
                                                                                          (Ms. Kemala Rita)                                                                          t
                                                                                                                                                                                             Visit to Hospice Palliative care

                                        (Dr. Masanori Mori)                                                                              nominate speakers
                                                                                                                                            (Jim Cleary)                             a
                                                                                                                                                                                     t
                          Quality improvement in palliative care (e.g.,      The Quality of Life of Cancer Patients with                                                             i
          14.30 -15.30    bereaved family survey, quality assessment)           Body Image and Sexual Dysfunction                                                                    o
                                   (Prof. Mitsunori Miyashita)                       (Christantie Effendy, PhD)                                                                      n

                              Satellite Symposium 4 --> Neurology                Satellite Symposium 5 --> Cirrhosis                    Satellite Symposium 6 --> Infection
          15.30 - 16.20
                                         (Dr. Mieko Ogino)                        (Prof. L. A. Lesmana SpPD, KGEH)

                                  What is the role of Palliative
                                                                              Palliative Care for People with Advanced         Antibiotic Therapy for Hospital Aquired Pneumonia
          15.30 - 15.50                 Care in Stroke?
                                                                                     Liver Disease: How to do it?                            (Dr. Shinichiro Morioka)
                                          (dr. Kohino)

                          What are special considerations are needed
                                                                              Advanced Pancreatic Billiary Cancer and            Sepsis in patients with weeks of life expectancy
          15.50 - 16.10   for patients with neurodegenerative disease
                                                                             Palliative Care : what is best for patients ?                    (Dr. Shinichiro Morioka)
                                           (dr. Kohino)

          16.10 - 16.20                       Q&A                                               Q&A                                                    Q&A

                                                                                                                               Palliative care in intensive care units and emergency
                                   Non cancer palliative care                    The Challenges in End of Life Care
                                                                                                                                                         rooms
          16.20 - 17.20   (or Psychosocial issues of family in pall care)               (Prof. Carmen Chan
                                                                                                                              (Dr. Janis Miyaski, or will ask Dr. Akhilesh to nominate a
                                        (Dr. Amy Chow)                          The Chinese University of Hongkong)
                                                                                                                                                       speaker)

                                                                                        Welcome Dinner / Cultural Night

                                          19.00 – 19.15                                                                       Opening

                                                                                                                 Speech of Chairman APHC 2019
                                          19.15 – 19.30
                                                                                                                   (Dradjat R.Suardi, MD, FICS)
          19.00 - 21.40
                                                                                                                         FORMAL SPEECH
                                          19.30 – 19.45
                                                                                                                 (Major of Surabaya Palliative City)

                                          19.45 – 21.30                                                     Dinner + Performance (traditional dance)

                                          21.30 – 21.40                                                                       Closing

www.aphc2019.com                                   The 13th Asia Pacific Hospice Conference, 2019, SURABAYA - INDONESIA
APHC 2019
   13th ASIA PACIFIC HOSPICE CONFERENCE

   SURABAYA - INDONESIA
                                                                                                                                                                      9
  THE 13th ASIA PACIFIC HOSPICE
  PALLIATIVE CARE CONFERENCE 2019
                                                                   Sunday, August 4th 2019
     TIME                                                                              EVENTS

  08.00 - 09.00                                                                     Meet the Expert

  09.00 - 09.30                                                       Coffee Break, Exhibition, and Poster Viewing

                                                                                  Concurrent Sessions

                                          Scientific Session 5                   Educational Session 5                                Scientific Session 6

                        End of Life Discussion and Advance Care
                          Planning in Asia and Pacific : Scope,
                                                                           Spiritual Aspect in Palliative Care                      Pediatric Palliative Care
                             Challenges, and Opportunities
                            ( Chair: Prof. Josephine Clayton)

                                                                            Spiritual Aspect in Palliative Care
                                                                                                                             Emergency in Pediatric Palliative Care
  09.30 - 11.00                                                         (dr. Urip Murtedjo,Sp.BKL(K), FINACS(K),
                                                                                                                               (Dr. Edi Setiawan Tehuteru, SpA(K)
                                                                                FICS.,PGD.Pall.Med(ECU))
                          Singapore (Dr. Sumytra Menon:OK)
                            Hong Kong (Dr. Annie Kwok: OK)
                                                                                                                      Neonatal Palliative Care: Experiene in Setting
                            Taiwan (Dr. Shao-Yi Cheng: OK)
                                                                            Ethical Issues in Palliative Care                      up in Asian Region
                          Korea (Lisa : Dr. Sun-hyun Kim: OK)
                                                                             (Prof W. F Maramis SpKJ (K))                (Dr. Chakra Vasuvedan--> or tentatives
                     Japan (Prof. Kizawa--> Dr. Sayaka Takenouchi:
                                                                                                                                  speaker from APHC)
                                           OK)
                       Netherland (Judith-->Dr. Diah Martina: OK)
                                                                                                                        Psychosocial Aspect in Neonatal Palliative
                                                                           Core Competence of Spiritual Care                              Care
                                                                         (Dr. Agus Ali Fauzi, PGD.Pall.Med (ECU)          (Dr. Chakra Vasuvedan--> or tentatives
                                                                                                                                   speaker from APHC))

                                                                                      PLENARY 5
  11.00 - 12.00                                                                  Advance Care Planning
                                                                       Prof. Marie Bakitas (University of Alabama)

  12.00 - 13.00                                                               Sposored Lunch Symposium

                                                                        Closing ceremony (Room 1 Grand City)

                                             13.00 – 13.10                                                        Opening

                                                                                                      Report Chairman APHC 2019
                                             13.10 – 13.30
                                                                                                      (Dradjat R.Suardi, MD, FICS)

  13.00 - 14.30                              13.30 – 13.45                                          Perform from next host: Japan

                                             13.45 – 14.00                                             Champion Announcement

                                            14.00 – 14.15                                                        DOORPRIZE

                                            14.15 – 14.30                                                          Closing

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10                                                                                  APHC 2019
                                                                                    13th ASIA PACIFIC HOSPICE CONFERENCE

                                                                                    SURABAYA - INDONESIA

                                                Abstract
                                   Submission Guidelines
  General Guidelines
  • We do not accept any work that has been published.
  • All abstracts have to be submitted in ENGLISH .
  • Abstracts will be evaluated based on their scientific content and novelty, and meritorious
  abstracts will be selected for oral presentation. All other shortlisted abstracts will be
  scheduled for poster presentation. Any abstract containing statements, symbols or
  other contact that are subjective and unscientific in nature will be rejected.

  Abstract Submission Topics
  • Clinical Ethics
  • Pain and Symptom Management
  • Palliative Care in Non-cancer
  • Ageing and Geriatrics
  • Paediatric Palliative Care
  • Bereavement, Grief and Loss
  • Spirituality and Psychological health
  • Arts and Humanities (including art and music therapy)
  • Policy or Programme Advocacy, Development and Evaluation
  • Professional Issues and the Professional Worker
  • Education, Training and Supervision
  • Advance Care Planning and Communication
  • Rehabilitation and Clinical Nutrition
  • Family Care-givers
  • Self-Care and Wellness
  • Complementary Therapies /Natural Anal gesics

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APHC 2019
    13th ASIA PACIFIC HOSPICE CONFERENCE

    SURABAYA - INDONESIA
                                                                                                      11
  Abstract
  Submission Guidelines
  Registration and Expenses
  All presenting authors must be registered for APHC. Authors who have not paid
  their registration fees will not be allowed to enter. All expenses associated with the
  submission and presentation of the abstract are the sole responsibility of the presenter.

  ABSTRACT CONTENT PREPARATION
  Language
  Abstracts must be written and presented in English. Careful typing and proofreading
  is essential. The accepted abstract will be published as submitted. Once the abstract
  is submitted, changes, corrections or rewording will not be possible.

  The Scientific Committee reserves the right to reject abstracts which are presented in
  poor English or to request an immediate revision.

  Word Count
  The maximum content of the abstract is limited to 3,000 characters (including title,
  body, spaces, tables and graphics). Each picture counts as 500 characters.

  Topic Selection
  Please choose the most appropriate topic from the drop down menu.

  Title
  The title should clearly define the topic of your research. Do not identify your institution
  in the title. There is no maximum length for the title. However, the characters in the title
  are included in your total character count. The first letter of any sentence in the title
  will automatically begin with a capital letter. Do not type the entire title in capital letters.

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12                                                                                  APHC 2019
                                                                                    13th ASIA PACIFIC HOSPICE CONFERENCE

                                                                                    SURABAYA - INDONESIA

                                               Abstract
                                  Submission Guidelines
  Author(s)
  Type the full name of all authors. Omit any titles, degrees and institutional affiliations.
  It is advisable to check the correct spelling of the family name and initials of each
  author. If authors are from the same institution, the name of the institution must be
  written in the exact same way.

  Affiliation
  Type the institution, Department, City and Country. if co-authors are from the same
  institution, the software will automatically copy all information into the subsequent
  boxes. You do not have to type the information again. if co-authors are not from the
  same institution, you can edit the boxes.

  Abstract Content
  The following headings have been formatted for you and should NOT be entered in
  the text fields :
  1. Introduction & objectives
  2. Materials & methods
  3. Results
  4. Conclusion
  State the objective of the study, describe the material and methods and summarise
  the results of the research. You need to present sufficient details to support the
  conclusions reached. Please use standard abbreviations and generic drug names.
  Abbreviations should be spelled out, in parentheses, in the first use in the abstract.
  You can use the special keys to insert tables, pictures or specific characters

  Data Protection Policy
  All patient information should be de-identified. Patient’s faces should be blurred when
  used in images. Seek necessary permission from the copyright owner if copyrighted
  figures, images, or content are used in the abstract

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APHC 2019
    13th ASIA PACIFIC HOSPICE CONFERENCE

    SURABAYA - INDONESIA
                                                                                                           13
  Abstract
  Submission Guidelines
  Acknowledgements
  Do not include references, credits or grant support in your abstract.

  Human Experimentation
  Any human experimentation conducted as part of the submitted abstract(s) must
  follow the protocol approved by the institutional or local committee on ethics in
  human investigation; or, if no such committee exists, the investigation should have
  been conducted in accordance with the principles of the World Medical Association’s
  Helsinki Declaration.

  Data Presentation
  Abstracts that describe investigations of compounds that involve inadequate numbers
  of study subjects, or abstracts that lack quantitative data may not be accepted. Authors
  should not “split” data to create several abstracts. Abstracts containing same data
  submitted from the same institution (and/or individuals) describing the same study
  population may be disqualified. Abstracts without data will not be considered.

  Submission Deadline
  Deadline for abstract submission is March 31st, 2019.
  To avoid incidences where your abstract cannot be submitted due to technical
  difficulties, computer problems or other reasons, you are advised to submit your
  abstract early.

  Important Dates to Note
  • March 31st, 2019   - Abstract submission close
  • February to March                      - Notification of abstract acceptance (Please register first
  				                                       in order to enjoy the early bird rate. You may make payment
  				                                       upon receiving the notification email that your abstract is
  				                                       accepted)
  • July 10th, 2019 		                     - Payment deadline

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14                                                                                             APHC 2019
                                                                                               13th ASIA PACIFIC HOSPICE CONFERENCE

                                                                                               SURABAYA - INDONESIA

                                                            Registration &
                                                           Accommodation
  REGISTRATION BY EMAIL                                  ROOM RATE
  To get a registration form can contact the             Hotel rooms at special congress rate are being
  secretariat at +62 315018840, +62 315501089            held for the congress participants Room rates
                                                         are in Dollar, per night and per room included
  ON SITE REGISTRATION                                   breakfast for two persons. Reservations must
  Those who have not registered in advance may           be made through the congress secretariat
  register at onsite registration desk. Cash payment     toguarantee the indicated rate negotiates for
  only in Rupiah and USD will be accepted during         the congress
  on site registration. No refund will be made for
  on site registration fees.                             HOTEL RESERVATION
                                                         Hotel assignment will be made on a “FIRST
  REGISTRATION PAYMENT                                   COME FIRST SERVE BASIS”.
  All registration fees must be paid by bank transfer.
  Registrant should bear all bank charges. Please        REGISTRATION AND ACCOMMODATION
  send copy of the transaction along with the            SECRETARIAT
  registration to the Organizing Committee.              INDONESIAN PALLIATIVE SOCIETY
                                                         c/o Palliative Care Building
  HOTEL POLICY                                           Dr. Soetomo General Hospital Surabaya
  Due to high demand on the hotel room at the time       Jl. Mayjend Prof. Dr. Moestopo No. 6 - 8,
  of congress, the congress secretariat strongly         Surabaya, Jawa Timur 60285
  recommended early reservations.                        Phone : +62 315018840, +62 31 5501089
                                                         Fax    : +62 31 5018840
                                                         Email : aphc2019surabaya@gmail.com

                                                         PAYMENT BY
                                                         Bank CIMB Niaga
                                                         CIMB Niaga Branch Surabaya
                                                         Acc Name       : Masyarakat Paliatif Indonesia
                                                         A/C		          : 800 - 15096 - 5700
                                                         Swift Code     : BNIAIDJA

www.aphc2019.com                      The 13th Asia Pacific Hospice Conference, 2019, SURABAYA - INDONESIA
APHC 2019
    13th ASIA PACIFIC HOSPICE CONFERENCE

    SURABAYA - INDONESIA
                                                                                                      15
  Registration &
  Accommodation Fee

  *Early bird registrasions have been extended until Sunday March, 31st 2019.
   abstract submissions have been extended until thursday February, 28th 2019.

www.aphc2019.com                           The 13th Asia Pacific Hospice Conference, 2019, SURABAYA - INDONESIA
16                                                                    APHC 2019
                                                                      13th ASIA PACIFIC HOSPICE CONFERENCE

                                                                      SURABAYA - INDONESIA

                                                            Tourism
 Mount Bromo Sunrise

 Suramadu Bridge

 Ijen Crater

www.aphc2019.com   The 13th Asia Pacific Hospice Conference, 2019, SURABAYA - INDONESIA
APHC 2019
   13th ASIA PACIFIC HOSPICE CONFERENCE

   SURABAYA - INDONESIA
                                                                                                                                                                                               17
                                                       Registration Form
                                           THE 13TH ASIA PACIFIC HOSPICE AND PALLIATIVE CARE CONFERENCE
                                                        GRAND CITY CONVEX SURABAYA, AUGUST 1st - 4th 2019
                    PARTICIPANT (Kindly Completed)

                    Title                                      : □ Prof        □ Dr    □ dr       □ Specialist        □ Other

                    Full Name                                  :

                    Membership Number                          :

                    Organization/Institution                   :

                    Mailing Address                            :

                    Country                                    :

                    Zip Code                                   :

                    Mobile Phone                               :

                    Email                                      :

                    Sponsor                                    :                                                                Name:

                    Mobile Phone                               :

                    Please Mark (√) on Workshop / Symposium you choose

                                                                                                                                    FEE FOR CONFERENCE
                       NO                              WORKSHOP                                             TYPE                                                       FOR WORKSHOP ONLY
                                                                                                                                         DELEGATES
                                □ Integration and Standard of Palliative Care in
                      □ 1a                                                                              Half Day (AM)                       □ 40 USD                           □ 100 USD
                                  Clinical Oncology

                      □ 1b      □ Comprehensive Assessment of Patients                                  Half Day (PM)                       □ 40 USD                           □ 100 USD

                       □2       □ Paediatric Palliative Care                                               Full Day                         □ 75 USD                           □ 200 USD
                                □ Mandarin Hospice Summit
                       □3                                                                                  Full Day                         □ 75 USD                           □ 200 USD
                                  (* session conducted in Chinese)

                      □ 4a      □ Pain Management                                                       Half Day (AM)                       □ 40 USD                           □ 100 USD

                      □ 4b      □ Wound and Stoma Care                                                  Half Day (PM)                       □ 40 USD                           □ 100 USD

                                □ Psychosocial, Spiritual Care and Therapeutic
                                  Communication in Palliative Care for Carers,
                      □ 5a                                                                              Half Day (AM)                       □ 30 USD                           □ 100 USD
                                  Volunteers and Caregivers
                                  (* Session conducted in Bahasa)

                                □ Psychosocial, Spiritual Care and Therapeutic
                                  Communication in Palliative Care for Doctors
                      □ 5b                                                                              Half Day (PM)                       □ 40 USD                           □ 100 USD
                                  and Health Practitioners
                                  (* Session conducted in Bahasa)

                                                                          TOTAL                                                   USD

                                                                                                                                     REGISTRATION FEE
                       NO                              SYMPOSIUM
                                                                                                         Early Bird                  Jan 1st - July 1st, 2019                    Onsite
                                                                   □ Doctors                              □ USD 600                         □ USD 650                          □ USD 700
                       □1         □ Developed Countries
                                                                   □ Non - Doctors                        □ USD 500                         □ USD 550                          □ USD 600

                                                                   □ Doctors                              □ USD 350                         □ USD 400                          □ USD 450
                       □2         □ Developing Countries
                                                                   □ Non - Doctors                        □ USD 200                         □ USD 250                          □ USD 300

                                                                          TOTAL                                                   USD
                    *Note: All APHN Individual Members are entitled to a 100 USD discount off the above price. Please provide your full name and membership number to enjoy the discount.
                            Equivalent currency USD 1 = IDR 15.500
                            Rate available ONLY to participants residing in countries listed as “Low” and “Lower middle

                    CANCELLATION AND REFUND POLICY
                    Written cancellation notice is required. Cancellation must be received before May 1st 2019 a 50% refund will be returned after congress ended. No refund will be allowed
                    thereafter

                    PAYMENT BY                                                                                                                                         SIGNATURE
                    Bank Name                   : CIMB Niaga Branch Surabaya
                    Account Number              : 800 - 15096 - 5700
                    Account Name                : Masyarakat Paliatif Indonesia
                    Swift Code                  : BNIAIDJA

                    Please quote the sender’s name on the bank transfer statement
                    When transmitting, please make sure who send the money possibly by fax.

                                                    THIS FORM TOGETHER WITH THE REQUISITEMENT PAYMENT AND/OR DOCUMENTATION SHOULD BE EMAILED/FAXED
                                                                TO: The Congress Secretariat: Phone: +62 315018840 +62 31 5501089 | Fax: +62 31 5018840
                                                                                          Email: aphc2019surabaya@gmail.com

www.aphc2019.com                                                                The 13th Asia Pacific Hospice Conference, 2019, SURABAYA - INDONESIA
18                                                                                                                                                                               APHC 2019
                                                                                                                                                                                 13th ASIA PACIFIC HOSPICE CONFERENCE

                                                                                                                                                                                 SURABAYA - INDONESIA

                                Accommodation Form
                           THE 13TH ASIA PACIFIC HOSPICE AND PALLIATIVE CARE CONFERENCE
                                 GRAND CITY CONVEX SURABAYA, AUGUST 1st - 4th 2019

                                             TH
     PARTICIPANT (Kindly Completed)

     Title                                   : □ Prof      □ Dr       □ dr       □ Specialist       □ Other

     Full Name                               :

     Membership Number                       :

     Organiza�on/Ins�tu�on                   :

     Mailing Address                         :

     Country                                 :

     Zip Code                                :

     Mobile Phone                            :

     Email                                   :

     Sponsor                                 :                                                                                                        Name:

     Mobile Phone                            :

     Please Mark (√) on Hotel you choose

        NO                                                  HOTEL                                                           ROOM TYPE                       RATE/NETT/NIGHT

        □1      Majapahit Hotel ( 5)                                                                                            Classic                             USD 85

        □2      Sheraton Surabaya Hotel & Towers ( 5)                                                                           Deluxe                             USD 105

        □3      JW Marrio� Hotel Surabaya ( 5)                                                                                  Deluxe                              USD 97

        □4      Bumi Surabaya City Resort ( 5)                                                                                  Classic                            USD 116

        □5      Wyndham Surabaya ( 5)                                                                                           Deluxe                             USD 65

        □6      Surabaya Suites Hotel ( 4)                                                                                  Business Suite                         USD 40

        □7      Four Points By Sheraton Surabaya ( 4)                                                                           Deluxe                             USD 85

        □8      Harris Hotel & Conven�ons Gubeng ( 4)                                                                           Harris                             USD 42

                                                        TOTAL                                                       USD

       Equivalent currency USD 1 = IDR 15.500

     CANCELLATION AND REFUND POLICY
     Written cancellation notice is required. Cancellation must be received before May 1 st 2019 a 50% refund will be returned after congress ended. No refund will be allowed
     thereafter

     PAYMENT BY                                                                                                                                          SIGNATURE
     Bank Name                 : CIMB Niaga Branch Surabaya
     Account Number            : 800 - 15096 - 5700
     Account Name              : Masyarakat Paliatif Indonesia
     Swift Code                : BNIAIDJA

     Please quote the sender’s name on the bank transfer statement
     When transmitting, please make sure who send the money possibly by fax.

                                 THIS FORM TOGETHER WITH THE REQUISITEMENT PAYMENT AND/OR DOCUMENTATION SHOULD BE EMAILED/FAXED TO:
                                              The Congress Secretariat: Phone: +62 31 5018840, +62 31 5501089 | Fax: +62 31 5018840
                                                                       Email: aphc2019surabaya@gmail.com

www.aphc2019.com                                                The 13th Asia Pacific Hospice Conference, 2019, SURABAYA - INDONESIA
Secretariat
         INDONESIAN PALLIATIVE SOCIETY
         c/o Palliative Care Building
         Dr. Soetomo General Hospital Surabaya
         Jl. Mayjend Prof. Dr. Moestopo No. 6 - 8, Surabaya,
         Jawa Timur 60285
         Phone : +62 31 5018840, +62 31 5501089
         Fax     : +62 31 5018840
         Email : aphc2019surabaya@gmail.com

www.aphc2019.com
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