7th Annual Intensive Physician Board Review Course in

Hospice and Palliative MedicineNovember 15–17, 2011

Supportive Care, Hospice and Palliative Medicine

November 18–19, 2011

15th Annual Interdisciplinary Conference on

The following Review Course will be offered prior to the Conference

The University of Texas MD Anderson Cancer CenterMain Building, Hickey Auditorium, 11th Floor

1515 Holcombe Boulevard, Houston, Texas

GoalCaring for the cancer patient in the advanced stage of illness is particularly challenging to the healthcare team. It requires attending to the many dimensions of care including medical, psychosocial, ethical and spiritual needs. This is the fifteenth year of the conference. It continues to be important to provide educational updates in the field of palliative and hospice care - which includes pain, other symptom management and end-of-life issues. We believe this conference will provide participants with practical information with which to better care for patients with advanced cancer and other illnesses and their families.

Educational ObjectivesAfter attending the conference, participants should be able to• identify the moral and ethical dilemmas facing clinicians

who provide end-of-life care (knowledge);• practice state-of-the-art pain and symptom management for

patients with advanced disease (knowledge, competence, performance, patient outcomes);

• demonstrate effective communication with patients in the advanced stages of cancer or debilitating disease and provide quality end-of-life care (knowledge, competence, performance);

• exhibit heightened awareness of the medical, legal and spiritual issues facing patients and families involved in the care of advanced disease (knowledge, competence).

Target AudienceThis program should be of interest to medical oncologists, psychiatrists, psychologists, ethicists, family practice physicians, anesthesiologists, nurses, social workers, clergy, physical therapists, occupational therapists, fellows, students, and physical medicine and rehabilitation physicians.

Educational MethodsLectures • Workshop Sessions • Case Studies

EvaluationA course evaluation form will provide participants with the opportunity to comment on the value of the program content to their practice decisions, performance improvement activities, or possible impact on patient health status. Participants will also have the opportunity to comment on any perceived commercial bias in the presentations as well as to identify future educational topics.

Accreditation/Credit DesignationThe University of Texas MD Anderson Cancer Center is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The University of Texas MD Anderson Cancer Center designates this live activity for a maximum of 15.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

EthicsThis course has been designated by The University of Texas MD Anderson Cancer Center for 15.25 AMA PRA Category 1 Credits™ in medical ethics and/or professional responsibility.

NursingThe University of Texas MD Anderson Cancer Center is an approved provider of continuing nursing education by the Texas Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

Nursing Continuing Education Contact Hours will be awarded.

CME Certificates and Attendance Verification CertificatesCertificates awarding AMA PRA Category 1 Credits™ or certificates documenting attendance will be distributed to participants when an individual departs the conference. To obtain a CME certificate, physicians must submit a completed evaluation questionnaire and a CME Verification Form. Upon receipt, a record of attendance (certificate) will be provided on-site to other health care professionals for requesting credits in accordance with state nursing boards, specialty societies, or other professional associations.

15th Annual Interdisciplinary Conference on

Supportive Care, Hospice and Palliative MedicineNovember 18–19, 2011

Sriram Yennu, MD (Chair)Maureen Valenza (Program Coordinator)Eric R. Gagneaux (Logistics Manager)Inez Rodriguez (Administrative Support)

Conference Organizing CommitteeEduardo Bruera, MD, FAAHPMDebra Castro, CHPM, RNJames Cavelier, Jr., MBA, MSN, RN (Nurse Planner) Susan Gaeta, MDHolly Holmes, MDDavid Hui, MD, MSc, FRCPCBill R. Kersten, MHA

Akhila Reddy, MDEden Mae Rodriguez, PharmDNatalie Schuren, RN, BSN, MSNKay Swint, MSN, RN, CHPNSteven Thorney, MDiv, MA, BCCCatherine Tilley, RN, MS, ANP-BCCarmella Wygant, OTR, MSW, LCSW

Friday, November 18, 20117:15 am Registration / Continental Breakfast

7:45 Welcome Sriram Yennu, MD

8:00 am Addressing an Unmet Need in Oncology Patients: Supportive Care for Dysfunction of Upper Aerodigestive Tract

Michael Kupferman, MD

8:45 SPECiAl WOrkSHOP SESSiON The Symptoms of Advanced Cancer T. DeClan Walsh, MD, FACP, FRCP 9:45 Break

10:00 WOrkSHOP SESSiONS i 1. Case Scenarios in Pain

Management: Pain Management and Opioid rotation

Akhila Reddy, MD 2. Doc, Does this Mean i’m Going

to Die? Surviving the Difficult Conversation with Patients and Their Families- Part i (Participants who attend this session must attend Part II)

Walter Baile, MD and Laura Morrison, MD

3. Private Practice Palliative Medicine Ana Leech, MD4. When Mommy and Daddy is Dying

Martha Aschenbrenner, MS

11:00 WOrkSHOP SESSiONS ii1. Supporting the Soul: integration

of Spiritual Care into Daily interdisciplinary Practice

Donna Zhukovsky, MD, FACP, FAAHPM and Steven Thorney, MDiv, MA, BCC

2. Management of Nutritional issues in End-of-life Care

Egidio Del Fabbro, MD3. intimate Partner Violence in an

Outpatient Palliative Care Setting Carmella Wygant, OTR, MSW, LCSW4. Doc, Does this Mean i’m Going

to Die? Surviving the Difficult Conversation with Patients and Their Families- Part ii (Participants must

attend Part I to attend this session) Walter Baile, MD and

Laura Morrison, MD

12:00 pm lunch / Grand rounds Effectiveness of Palliative Care

Service on Cost of Care and Quality of life

Eduardo Bruera, MD, FAAHPM and Sriram Yennu, MD

1:30 Methadone for Cancer Pain. Can it be Used as a First-line Opioid

Suresh K. Reddy, MD, FFARCS

2:30 WOrkSHOP SESSiONS iii1. Professional Burnout in

Palliative Care Warren Holleman, PhD2. radiation Oncology in Palliative Care David Howell, MD3. COllAGE: The Art for Cancer

Network – innovative Art Programs for Patients and Family Members

Jennifer Wheler, MD and Oncology Massage and the

Power of Touch Curtiss Beinhorn, RMT4. Personalized Pain Goal – What are the

latest Guidelines for Pain Management for End-of-life Care

Shalini Dalal, MD 3:30 Break 3:45 8th Annual John Mendelsohn Award 2011 Ceremony and introduction

of keynote Speaker Eduardo Bruera, MD, FAAHPM 4:00 8th Annual John Mendelsohn Award

for Outstanding Contributions in the Development of the Field of Palliative Care Presentation

Crossroads in Palliative Care in America: Where Are We Heading?

T. Declan Walsh, MD, FACP, FRCP Moderator: Eduardo Bruera, MD, FAAHPM 5:00 rAPiD FirE SESSiONS:

1. Choices and Confidence: Pain Management Choices in Adults living with HiV/AiDS

Sabrina Q. Mikan, RN, ACNS-BCC2. Frequency and Predictors of Patient

Deviation from Prescribed Opioids and Barriers to Opioid Pain Management in Advanced Cancer Patients

Linh Nguyen, MD 3. Frequency Predictors of Pain response in

an Outpatient Supportive Care Clinic Jung Hun Kang, PhD4. Correlation Between Patient reported

Symptoms and Nurses’ Clinical impression in Cancer Patients Admitted to an Acute Palliative Care Unit

Wadih Rhondali, MD5. Undiagnosed Alcoholism and its

relationship with Tobacco and illegal Drug Use in Advanced Cancer Patients Rony Dev, DO

6:15 pm Adjourn

Saturday, November 19, 20117:30 am Registration / Continental Breakfast 8:00 Special Workshop Gender Difference in Grief Styles Kenneth Doka, PhD 9:00 2011 lifetime Nursing Achievement Award Ceremony and introduction of keynote

Speaker Kay Swint, MSN, RN, CHPN

9:15 The University of Texas MD Anderson Cancer Center Palliative and Hospice Care lifetime Nursing Achievement Award Presentation

The Well-Being of Family Caregivers as a Determinant of Quality Care for Patients

Deborah Witt Sherman, PhD, CRNP, ANPBC, ACHPN, FAAN

Moderator: Kay Swint, MSN, RN, CHPN 10:15 Break 10:30 WOrkSHOP SESSiONS iV

1. Tips for the Caregiver: Anticipatory Grief, How Do i identify and Manage

Kenneth Doka, PhD2. Preventive Medications in Hospice:

When Do We Stop? Holly Holmes, MD3. Childhood Sexual Abuse in Advanced

Cancer Patient in the Palliative Setting Carmella Wygant, OTR, MSW, LCSW4. Prognostication 201:Advances in

Survival Prediction for Patients with Advanced Cancer

David Hui, MD, MSc, FRCPC 11:30 WOrkSHOP SESSiONS V

1. Managing Agitated Delirium Ahmed Elsayem, MD2. Understanding Competency in the

Terminally ill Patient Ruth Wagner, LMSW, ACHP-SW and

Tziona Regev, LMSW3. A Case Study of a Music Therapy

Session in inpatient Palliative Care Ingrid Sevy Moeller, MA, MT-BC and PAWS: Houston Personal Pet

Visitations in an Acute Care Setting-Making it Happen

Frank Scott4. Subcutaneous Hydration and

Medication Use for Symptom Control Paul W. Walker, MD

12:30 pm Lunch 1:00 SPECiAl WOrkSHOP SESSiON improving Palliative/Hospice

Practice: Defining Components of Quality Palliative Care in Daily Clinical Care of Patients with life limiting illness

Deborah Witt Sherman, PhD, CRNP, ANPBC, ACHPN, FAAN

2:00 WOrkSHOP SESSiON Vi

1. How to Make an Effective Poster Presentation

Holly Holmes, MD2. Telephonic Supportive Care:

Challenges of Caring for Ambulatory Distressed Patients

Debra Castro, CHPM, RN; Lindsey Pimentel, RN and Liz Brown, OCN, RN

3. Transitioning to Comfort Care: it is All About Communication

Susan Gaeta, MD 3:00 Overview of recent research and

Conclusion Eduardo Bruera, MD, FAAHPM 3:45 pm Conference Adjourns

15th Annual Interdisciplinary Conference on

Supportive Care, Hospice and Palliative MedicineNovember 18–19, 2011

7th Annual Intensive Physician Board Review Course in Hospice and Palliative MedicineNovember 15–17, 2011

GoalCaring for the cancer patient in the advanced stages of disease is particularly challenging to the healthcare team. It requires attend-ing to the many dimensions of care including medical, psychosocial, ethical, and spiritual needs. In the seventh year, the Intensive Board Review Course in Hospice and Palliative Medicine continues to offer participants educational updates and literature review to help them successfully take the certification examination.

Educational ObjectivesAfter attending the conference, participants should be able to• identify and interpret the moral and ethical dilemmas

encountered at the end-of-life (knowledge, competence);• provide optimal end-of-life care to include state of the art pain

and symptom management for patients with advanced disease (knowledge, competence, performance, patient outcomes);

• apply effective communication techniques with patients in the advanced stages of cancer or debilitating disease and provide end-of-life care (knowledge, competence, performance);

• effectively discuss the medical, legal, and spiritual issues facing patients with advanced disease (knowledge, competence).

Target AudienceThis program will be of interest to hospice and palliative care physicians, medical oncologists, family practice physicians, anesthesiologists, psychiatrists, advance practice nurses, and other health care professionals involved in hospice and palliative care.

Educational MethodsLectures • Case Studies • Meet the Professor Sessions

EvaluationA course evaluation form will provide participants with the opportunity to comment on the value of the program content to their practice decisions, performance improvement activities, or possible impact on patient health status. Participants will also have the opportunity to comment on any perceived commercial bias in the presentations as well as to identify future educational topics.

Accreditation/Credit DesignationThe University of Texas MD Anderson Cancer Center is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The University of Texas MD Anderson Cancer Center designates this live activity for a maximum of 27.25 AMA PRA Category 1 Credits™. Physicians should claim only credit commensurate with the extent of their participation in the activity.

EthicsThis course has been designated by The University of Texas MD Anderson Cancer Center for 27.25 AMA PRA Category 1 Credits™ in medical ethics and/or professional responsibility.

CME Certificates and Attendance Verification CertificatesCertificates awarding AMA PRA Category 1 Credits™ or certificates documenting attendance will be distributed to participants when an individual departs the conference. To obtain a CME certificate, physicians must submit a completed evaluation questionnaire and a CME Verification Form. Upon receipt, a record of attendance (certificate) will be provided on-site to other health care professionals for requesting credits in accordance with state nursing boards, specialty societies, or other professional associations.

Tuesday, November 15, 20117:15 am Registration / Continental Breakfast 8:00 introduction and General Overview of

Course: How to Take the Exam Sriram Yennu, MD

8:15 Pediatric Palliative Care Donna S. Zhukovsky, MD, FACP, FAAHPM

9:45 Break

10:00 Palliative Care in the last Week of life: Signs and Symptoms in the last 24 Hours/Hydration/Oral Secretions/Communicating about impending Death/Management of the Death rattle/Delirium

Eduardo Bruera, MD, FAAHPM

11:00 Pain: Assessment and Principles Larry Driver, MD

12:15 pm lunch: Meet the Professor Session Case Presentation/Discussion Donna S. Zhukovsky, MD, FACP, FAAHPM

1:00 Disease Specific Palliative Care, Cardiac, Pulmonary, and renal Sandra Gomez, MD

2:00 Dyspenea/Cough - Q and A Eduardo Bruera, MD, FAAHPM

3:00 Break

3:15 Medicare and Hospice issues: Face to Face/Dual Certifications/recertification

Susan Krauter, MD, FAAHPM

4:15 Grief and Bereavement Rony Dev, DO

5:15 Chemotherapy and radiation: Principles and Common Adverse Effects

David Hui, MD, MSc, FRCPC

6:15 pm Adjourn

Wednesday, November 16, 20117:30 am Registration / Continental Breakfast

8:00 Palliative Care Emergencies Shalini Dalal, MD

9:30 Break

9:45 Delirium, Palliative Sedation, and Opioid induced Neurotoxicity

Eduardo Bruera, MD, FAAHPM

11:15 Geriatric Palliative Care Sriram Yennu, MD

12:00 pm lunch: Meet the Professor Session Case Presentation/Discussion Eduardo Bruera, MD, FAAHPM

1:00 Adjuvant intervention and integrative Approaches in Pain Management

Suresh K. Reddy, MD, FFARCS

2:00 Cachexia/ Nausea/Vomiting/Bowel Obstruction/Constipation

Shalini Dalal, MD

3:00 Break

3:15 Communication and interdisciplinary Team Work Dynamics

Suresh K. Reddy, MD, FFARCS 4:15 Prognostication 201: Advances in Survival

Prediction for Patients with Advanced Cancer David Hui, MD, MSc, FRCPC

5:15 Opioid Titration and rotation- Q and A Suresh K. Reddy, MD, FAARCS

6:15 pm Adjourn

Thursday, November 17, 20116:30 am Registration / Continental Breakfast

7:00 Meet the Professor Session Case Presentation/Discussion Susan Krauter, MD, FAAHPM

8:00 Psychosocial and Spiritual issues Marvin Delgado-Guay, MD

9:00 Management of Anxiety/Depression at the End-of-life

Marvin Delgado-Guay, MD

9:45 Break

9:55 Common Pharmacological interactions in Palliative Care

Holly Holmes, MD

10:30 Palliative Care Non-Cancer Diagnosis Susan Krauter, MD, FAAHPM

11:15 lunch: Meet the Professor Session Case Presentation/Discussion Larry Driver, MD and

Suresh K. Reddy, MD, FFARCS

12:30 pm Fatigue and Sleep Disturbance Sriram Yennu, MD

1:30 Psycho-Social issues related to Perinatal/ Pediatric Palliative Care and Hospice

Susan Krauter, MD, FAAHPM

2:30 Break

2:45 Wound Care/Pressure Ulcers/ Pruritis / Xerostomia

Paul W. Walker, MD

3:30 Ethical and legal Decision Making Donna S. Zhukovsky, MD, FACP, FAAHPM

5:00 Conclusion and Overview of Course Material Sriram Yennu, MD

5:15 pm Adjourn

Board review Organizing Committee

Sriram Yennu, MD (Chair)Maureen Valenza (Program Coordinator)Eric R. Gagneaux (Logistics Manager)Inez Rodriguez (Administrative Support)

Eduardo Bruera, MD, FAAHPMShalini Dalal, MDEgidio Del Fabbro, MDRony Dev, DOAhmed F. Elsayem, MDSandra Gomez, MDSue Krauter, MD, FAAHPMSuresh K. Reddy, MD, FFARCSPaul W. Walker, MDDonna S. Zhukovsky, MD, FACP, FAAHPM

MD Anderson Faculty Martha Aschenbrenner, MSWalter Baile, MDCurtiss Beinhorn, RMTLiz Brown, OCN, RNEduardo Bruera, MD, FAAHPMDebra Castro, CHPM, RNShalini Dalal, MDEgidio Del Fabbro, MDRony Dev, DOLarry Driver, MDAhmed F. Elsayem, MDSusan Gaeta, MDWarren Holleman, PhDHolly Holmes, MDDavid Hui, MD, MSc, FRCPCJung Hun Kang, PhDMichael Kupferman, MDIngrid Sevy Moeller, MA, MT-BCLindsey Pimentel, RNAkhila Reddy, MDSuresh K. Reddy, MD, FFARCSWadih Rhondali, MDKay Swint, MSN, RN, CHPNSteven Thorney, MDiv, MA, BCCPaul W. Walker, MDJennifer Wheler, MDCarmella Wygant, OTR, MSN, LCSWSriram Yennu, MDDonna S. Zhukovsky, MD, FACP, FAAHPM

Guest Faculty Kenneth Doka, PhDHospice Foundation of AmericaWashington, DC

Marvin Delgado-Guay, MDThe University of Texas Medical SchoolHouston, Texas

Sandra Gomez, MDMemorial HermannThe Woodlands, Texas

David Howell, MDUniversity of MichiganAnn Arbor, Michigan

Susan Krauter, MD, FAAHPMHouston HospiceHouston, Texas

Ana Leech, MDMemorial Hermann HospitalHouston, Texas

Sabrina Q. Mikan, RN, ACNS-BCCThe University of Texas at AustinAustin, Texas

Laura Morrison, MDBaylor College of MedicineHouston, Texas

Linh Nguyen, MDMemorial Hermann HospitalHouston, Texas

Tziona Regev, LMSWHarris County Hospital DistrictHouston, Texas

Frank ScottPAWS HoustonHouston, Texas

Deborah Witt Sherman, PhD, CRNP, ANPBC, ACHPN, FAANUniversity of MarylandBaltimore, Maryland

Ruth Wagner, LMSW, ACHP-SWBuckner HospiceHouston, Texas

T. DeClan Walsh, MD, FACP, FRCPCleveland ClinicCleveland, Ohio

Thank YouWe would like to thank the following palliative and hospice care organizations for their contribution to the 15th Annual Interdisciplinary Conference on Supportive Care, Hospice and Palliative Medicine and the 7th Annual Intensive Physician Board Review Course in Hospice and Palliative Medicine.

• Memorial Hermann Home Health and Hospice

• Silverado Hospice

At time of printing

Registration Information

7th Annual Intensive Physician Board Review Course – November 15-17, 2011• On-site registration and check-in opens at 7:15 am on Tuesday, November 15, 2011,

in the Hickey Auditorium Foyer on the 11th Floor of R. Lee Clark Clinic, MD Anderson, 1515 Holcombe Boulevard, Houston, Texas.

• The opening session will begin at 8:00 am on Tuesday, November 15, 2011, in Hickey Auditorium and Anderson Conference Hall, and will adjourn at 5:15 pm on Thursday, November 17, 2011.

The Physician Board Review Course registration fee includes materials, continental breakfasts, lunches, and breaks; however, it DOES NOT include registration to the 15th Annual Conference.

15th Annual Interdisciplinary Conference on Supportive Care, Hospice and Palliative Medicine – November 18-19, 2011• On-site registration and check-in opens at 7:15 am on Friday, November 18, 2011, in the

Hickey Auditorium Foyer on the 11th Floor of R. Lee Clark Clinic, MD Anderson, 1515 Holcombe Boulevard, Houston, Texas.

• The opening session of the conference will begin at 7:45 am on Friday, November 18, 2011, in Hickey Auditorium, and the conference will adjourn at 3:45 pm on Saturday, November 19, 2011.

The Conference registration fee includes the tuition, materials, continental breakfasts, lunches, and breaks; however, it DOES NOT include registration to the Physician Board Review Course.

The Deadline for Advance registration is October 28, 2011

There are three ways to register:• Mail to Department of CME/Conference Management, Unit 1381, The University of Texas

MD Anderson Cancer Center, PO Box 301439, Houston, TX 77230-1439• Fax to 713-794-1724• On-line at www.mdanderson.org/conferences

We accept the following forms of payment:• Check (payable to The University of Texas MD Anderson Cancer Center through

U.S. banks only)• Money order• Credit cards (MasterCard, VISA, and American Express)• Cash (on-site registration only)

A receipt and confirmation letter will be sent to you within ten working days of receipt of your registration.

Refund/Cancellation PolicyThe registration fee, minus a $50 administration-handling fee, is refundable if a written request is received on or before October 28, 2011. No refunds will be granted after that date. The request for a registration refund must include the tax identification number of the company or institution if registration was paid by a company or institution check. Although no refunds will be granted after October 28, 2011, you may transfer your registration to a colleague. For additional information, contact CME/Conference Management at 713-792-2223 or toll free at 866-849-5866, or via e-mail: register@mdanderson.org

The Department of CME/Conference Management reserves the right to cancel activities prior to the scheduled date, if low enrollment or other circumstances make it necessary. Each registrant will be notified by mail, e-mail, or at the phone or fax numbers given on the registration form.

In case of activity cancellation, the liability of the Department of CME/Conference Management is limited to the registration fee. CME/Conference Management will refund the full registration fee. The Department of CME/Conference Management reserves the right to limit the number of participants in a program and is not responsible for any expenses incurred by an individual whose registration is not confirmed and for whom space is not available.

Special AssistanceContact the Department of CME/Conference Management at 713-792-2223 or toll free at 866-849-5866 if you have any special dietary or ADA accommodation needs.

AccommodationsThe conference is providing a block of rooms at the Houston Marriott at the Texas Medical Center Hotel, 6580 Fannin Street, Houston, TX 77030 - (713) 796-0080.

When making hotel reservations be sure to use the Group Rate code of PllPllA to obtain the $139 room rate for single/double occupancy. Please add 17% Texas State and local taxes.

You may also visit www.hotels.com for other hotels within the Texas Medical Center area of Houston, Texas.

Air Travel – Continental AirlinesThe University of Texas MD Anderson Cancer Center has a program with Continental Airlines for discounted air travel. For discounts, call your travel professional or Continental’s Meeting Works toll free at 800-468-7022. Outside of the United States, please call your local Continental Airlines Reservation Office. The offer code is Z Code: ZJMD and Agreement Code: 325945.

Lower fares may be available on the internet or through your travel agency.

Ground Transportation (prices are subject to change)

• Houston is served by two airports, George Bush Intercontinental (IAH) and William P. Hobby (HOU).

• Taxicabs are available at an estimated cost of $30-60, to or from both airports.

• Super Shuttle operates a shuttle bus from both airports at an estimated cost of $24-$27 one-way and $48-$54 round-trip. For more information, call 713-523-8888 or toll-free at 800-258-3826 or on-line at www.supershuttle.com.

The University of Texas MD Anderson Cancer Center has implemented a process whereby everyone who is in a position to control the content of an educational activity must disclose all relevant financial relationships with any commercial interest that could potentially affect the information presented. MD Anderson also requires that all faculty disclose any unlabeled use or investigational use (not yet approved for any purpose) of pharmaceutical and medical device products. Specific disclosure will be made to the participants prior to the educational activity.

Agendas are subject to change because we are always striving to improve the quality of your educational experience. MD Anderson may substitute faculty with comparable expertise on rare occasions neces-sitated by illness, scheduling conflicts, and so forth.

Photographing, audio taping and videotaping are prohibited.

Please let us know what specific topics, issues or questions you wish to see addressed or emphasized in this activity. Call or e-mail CME/Conference Management. All responses will be forwarded to the Program Chairs for consideration.

CONFERENCE REGISTRATION - 056315th Annual interdisciplinary Conference on Supportive Care,Hospice and Palliative Medicine – November 18–19, 2011

intensive Physician Board review Course in Hospice and Palliative Medicine – November 15–17, 2011

7th Annual intensive Physician Board review Course – November 15–17, 2011 Physician/Scientist(MD, PhD, includes Resident, Fellow, etc.)1 Postmarked by 10/28/2011 .............................$650 You must register seperately if you wish to attend the Palliative Care Conference. Board Review Course registration DOES NOT include the Conference.

15th Annual interdisciplinary Conference on Supportive Care,Hospice and Palliative Medicine – November 18–19, 2011

Physician/Scientist (MD, PhD)1 Postmarked by 10/28/2011............$3501 Postmarked after 10/28/2011 ........$400

Healthcare Professional (Nurse, Hospice, Clergy, Ethicist, Social Worker, PT, PA, etc.)1 Postmarked by 10/28/2011............$2501 Postmarked after 10/28/2011 ........$300

Student/Trainee (Fellow, Resident)1 Postmarked by 10/28/2011............$1001 Postmarked after 10/28/2011 ........$150

MD Anderson - Physician/Scientist (MD, PhD)1 Postmarked by 10/28/2011............$2001 Postmarked after 10/28/2011 ........$250

MD Anderson - Healthcare Professional(Nurse, Hospice, Clergy, Ethicist, Social Worker, PT, PA, etc.)1 Postmarked by 10/28/2011............$1501 Postmarked after 10/28/2011 ........$200

Last Name First MI Highest Degree

Department (include box no.) Specialty

Institution

Street City State/Foreign Country/Zip or Mail Code

Daytime Phone (with area code) Cell Phone (with area code) Fax (with area code)

E-mail Address Emergency Contact Phone (with area code)

Charge the following: oVISA oMasterCard oAmerican Express

Credit Card Number or MD Anderson Interdepartmental Transfer (IDT) No. Expiration Date

Credit Card Holder Name (First/Last) Credit Card Holder Billing Address & ZIP Code

Authorized Signature REQUIRED for credit card or IDT MD Anderson Employee ID No. (REQUIRED)

IDT Approver Name (First/Last) please print IDT Approver E-mail

THiS iS NOT A SElF-MAilEr - ADDrESS TO:

Palliative Care Conference & Board Review

Department of CME/Conference Management – Unit 1381The University of Texas

MD Anderson Cancer Center PO Box 301439

Houston, TX 77230-1439or fax to 713-794-1724

Make check or money order payable to:

The University of Texas MD Anderson Cancer Center

Board review Attendees - Special rate Physician/Scientist (MD, PhD, includes Resident, Fellow, etc.)1 Postmarked by 10/28/2011............$150

TMC - Student/Trainee (Fellow, Resident)1 Postmarked by 10/28/2011........ $100

TMC - Physician/Scientist (MD, PhD)1 Postmarked by 10/28/2011......... $200

TMC - Healthcare Professional(Nurse, Hospice, Clergy, Ethicist, Social Worker, PT, PA, etc.)1 Postmarked by 10/28/2011......... $150

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