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BHS ± Center registration form

1

Hospital

Name Cliniques Universitaires de Bruxelles Short name Hôpital Erasme

Address Route de Lennik 808

1070 Bruxelles Telephone +32 (0) 2 555 31 11

Directions to

the hospital (link) http://www.erasme.ulb.ac.be/page.asp?id=214&langue Website www.erasme.ulb.ac.be

Clinical Hematology

Website http://www.erasme.ulb.ac.be/page.asp?id=8833&langue=FR Head of Dpt Name Pr Dominique Bron Tel +32 (0) 555 55 93 E-mail Dominique.Bron@ulb.ac.be Name Pr Virginie De Wilde +32 (0) 555 57 07 Virginie.de.wilde@erasme.ulb.ac.be

Secretary Name Mme Mora Diane Kalo Tel +32 (0) 555 36 60 E-mail secretaria-medical.hematologie@erasme.ulb.ac.be

Senior staff

(Internists with special competence in hematology) Name Pr Virginie De Wilde Tel +32 (0) 555 57 07 E-mail Specialization Name Pr Fleur Samantha Benghiat Tel +32 (0) 555 85 87 E-mail Specialization Name Dr Pierre Antoine Tel +32 (0) 555 51 93 E-mail Specialization Name Dr Sarah Buntinx Tel +32 (0) 555 57 90 E-mail Specialization Name Dr Françoise Le Moine Tel +32 (0) 555 32 07 E-mail Specialization Name Dr Marie Maerevoet Tel +32 (0) 555 36 60 E-mail Specialization Name Dr Anne De Weweire Tel +32 (0) 555 36 60 E-mail Specialization Name Dr Mélanie Vaes Tel +32 (0) 555 36 60 E-mail Specialization Name Dr Géraldine Claes Tel +32 (0) 555 32 07 E-mail Specialization

Name Tel E-mail Specialization

Psychologists Name Mr Denis Walravens Tel +32 (0) 555 81 72 E-mail denis.walravens@erasme.ulb.ac.be

Name Tel E-mail

Transplant

coordinator Name Tel E-mail Liaison nurses Name Mme Yamina Dkhissi Tel +32 (0) 555 85 70 E-mail Yamina.Dkhissi@erasme.ulb.ac.be Name Mme Pascale Vachaudez Tel +32 (0) 555 85 70 E-mail Pascale.Vachaudez@erasme.ulb.ac.be

BHS ± Center registration form

2

Clinical

research associates Name Mme Lucy Edwards Tel +32 (0) 555 37 53 E-mail Lucy.Edwards@erasme.ulb.ac.be Name Mme Elizabeth Garforth Tel +32 (0) 555 42 39 E-mail Elizabeth.Garforth@erasme.ulb.ac.be

Name Tel E-mail

Name Tel E-mail

Name Tel E-mail

Name Tel E-mail

Hospitalization Tel +32 (0) 555 37 26 Head nurse Mme Greta DEVILLE

Tel Head nurse

Daycare clinic Tel +32 (0) 555 46 05 Head nurse

Consultations

Tel +32 (0) 555 39 40 Address Hôpital de Jour, 1er étage, Route de Lennik 808, 1070 Bruxelles

Tel Address

Tel Address

Tel Address

Tel Address

Thrombosis/hemostasis (in same hospital) (if separate from clinical Hematology)

Website

Head of Dpt Name Pr Serge Motte Tel +32 (0) 555 57 03 E-mail serge.motte@erasme.ulb.ac.be

Secretary Name Tel E-mail

Senior staff

Name Dr Axelle Gilles Tel +32 (0) 555 36 60 E-mail Specialization Name Dr Sarah Buntinx Tel +32 (0) 555 57 90 E-mail Sarah.buntinx@erasme.ulb.ac. be Specialization

Name Tel E-mail Specialization

Name Tel E-mail Specialization

Name Tel E-mail Specialization

BHS ± Center registration form

3 Hematopoietic tissue bank and cell therapy unit (in same hospital) Website http://www.bordet.be/fr/services/servmed/martiat/pratic.htm Head of Dpt Name Pr Philippe Lewalle Tel +32 (0) 2 541 37 27 E-mail philippe.lewalle@bordet.be

Secretary Name Tel +32 (0) 2 541 37 16 E-mail

Senior staff

Name Tel E-mail Function

Name Tel E-mail Function

Name Tel E-mail Function

Name Tel E-mail Function

Name Tel E-mail Function

Laboratory Hematology (in same hospital)

Website http://www.erasme.ulb.ac.be/page.asp?id=16737&langue=FR Head of Dpt Name Pr Olivier Pradier Tel +32 (0) 555 54 92 E-mail Olivier.Pradier@erasme.ulb.ac.be Secretary Name Tel +32 (0) 555 39 25 E-mail secretariat.labo-iht@erasme.ulb.ac.be

Senior staff

(specialized in hematology) Name Dr Elena Lazarova Tel +32 (0) 555 59 13 E-mail elena.lazarova@erasme.ulb.ac. be Specialization Name Dr Julie Smet Tel +32 (0) 555 81 46 E-mail Julie.Smet@erasme.ulb.ac.be Specialization

Name Tel E-mail Specialization

Name Tel E-mail Specialization

Name Tel E-mail Specialization

BHS ± Center registration form

4

Other laboratories (in same hospital)

Cytology

Bone marrow

Name Pr Olivier Pradier Tel +32 (0) 555 54 92 E-mail Olivier.Pradier@erasme.ulb.ac.be

Name Tel E-mail

Pathology

Bone marrow

Name Dr Anne-Laure Trepant Tel +32 (0) 555 58 60 E-mail Anne-Laure.Trepant@erasme.ulb.ac.be

Name Tel E-mail

Pathology

Lymph nodes

Name Dr Anne-Laure Trepant Tel +32 (0) 555 58 60 E-mail Anne-Laure.Trepant@erasme.ulb.ac.be

Name Tel E-mail

Cytogenetics Name Pr Pierre Heimann Tel +32 (0) 555 51 40 E-mail Pierre.Heimann@erasme.ulb.ac.be

Name Tel E-mail

Molecular

biology Name Pr Pierre Heimann Tel +32 (0) 555 51 40 E-mail Pierre.Heimann@erasme.ulb.ac.be

Name Tel E-mail

Nuclear

medicine Name Pr Serge Goldman Tel +32 (0) 555 53 72 E-mail serge.goldman@erasme.ulb.ac.be

Name Tel E-mail

Radiotherapy for hematology patients (in same hospital)

Senior staff

Name Dr Martine Roelandts Tel +32 (0) 541 38 00 E-mail Martine.roelandts@bordet.be

Name Tel E-mail

Name Tel E-mail

Name Tel E-mail

Coordinator Name Tel E-mail

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