kat - albme · kat . kathy house, ms state opioid coordinator . alabama department of mental health...

12
We have been working very hard to have primary care professionals attend behavioral health conferences like ASADS. Now we have the opportunity to send professionals working substance abuse behavioral health settings to attend the Prescribing and Pharmacology of Controlled Drugs conference in November presented by the Medical Association of Alabama. ADMH through partnership with ADPH will pay the registration fee ONLY for professionals working in substance abuse behavioral health settings. The conference is November 22-24, 2019 at Hyatt Regency Birmingham-The Wynfrey Hotel, 1000 Riverchase Galleria, Birmingham, Ala. There's also several brochures attached for your review. If you are interested in attending, please complete the Medical Association Registration form and email it back to me at [email protected] or fax to 334-242-3025 by Oct 1, 2019. PLEASE DO NOT SEND YOUR REGISTRATION FORM TO THE MEDCIAL ASSOCIATION. If you have any questions please reach out to me. Kat Kathy House, MS State Opioid Coordinator Alabama Department of Mental Health Mental Health and Substance Abuse Services Division P.O. Box 301410 Montgomery, Alabama 36130-1410 334-242-3218 334-242-0759 (fax) www.mh.alabama.gov

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Page 1: Kat - ALBME · Kat . Kathy House, MS State Opioid Coordinator . Alabama Department of Mental Health . Mental Health and Substance Abuse Services Division P.O. Box 301410 . Montgomery,

We have been working very hard to have primary care professionals attend behavioral health conferences like ASADS. Now we have the opportunity to send professionals working substance abuse behavioral health settings to attend the Prescribing and Pharmacology of Controlled Drugs conference in November presented by the Medical Association of Alabama.

ADMH through partnership with ADPH will pay the registration fee ONLY for professionals working in substance abuse behavioral health settings. The conference is November 22-24, 2019 at Hyatt Regency Birmingham-The Wynfrey Hotel, 1000 Riverchase Galleria, Birmingham, Ala. There's also several brochures attached for your review.

If you are interested in attending, please complete the Medical Association Registration form and email it back to me at [email protected] or fax to 334-242-3025 by Oct 1, 2019.

PLEASE DO NOT SEND YOUR REGISTRATION FORM TO THE MEDCIAL ASSOCIATION.

If you have any questions please reach out to me.

Kat

Kathy House, MS State Opioid Coordinator Alabama Department of Mental Health Mental Health and Substance Abuse Services Division P.O. Box 301410 Montgomery, Alabama 36130-1410 334-242-3218 334-242-0759 (fax) www.mh.alabama.gov

Page 2: Kat - ALBME · Kat . Kathy House, MS State Opioid Coordinator . Alabama Department of Mental Health . Mental Health and Substance Abuse Services Division P.O. Box 301410 . Montgomery,

7:00 a.m. Registration and Light Breakfast (Registered attendees only)

7:30 a.m. – 8:30 a.m. Protecting your Patients and your Practice – Policies and Procedures of the Alabama Board of Medical Examiners Beverly F. Jordan, MD | Professional Medical Associates, PC, Enterprise | ALBME*

8:30 a.m. – 9:15 a.m. Protocols and Pitfalls: Part I – Policy Updates from the Alabama Board of Nursing Dawn B. Daniel, MSN, RN | Advanced Practice Nurse Consultant | Alabama

Board of Nursing

9:15 a.m. – 9:30 a.m. Break (Registered attendees only)

9:30 a.m. – 10:15 a.m. Protocols and Pitfalls: Part II Procedures and Profi ciencies for Collaborative Practice and Registration Agreements Patricia B. Ward, RN | Collaborative Practice Nurse Consultant, Alabama Board of Medical Examiners Donna Jordan, MPA | Director of Assistants to Physicians | Alabama Board of Medical Examiners

10:15 a.m. – 11:00 a.m. Primary Pitfalls of Controlled Substance Prescribing for Advanced Level Practitioners and the Path to Preventing Problems Amy M. Wybenga, CRNP | Collaborative Practice Nurse Consultant | Alabama Board of Medical Examiners

11:00 a.m. – 11:45 a.m. Panel of All Speakers

11:45 a.m. Evaluation and CME Claim Form (Complete and turn in to receive CME Credit)

Agenda subject to change*Alabama Board of Medical Examiners Board Member

Collaborative and Supervisory

Practices: Pearls, Pitfalls and Protocols

Hyatt Regency Birmingham – The

Wynfrey HotelPresented by the Medical Association of the State of Alabama, the Alabama Board of Medical Examiners, and the Alabama Board of Nursing

Nov. 22, 2019 | Agenda

Page 3: Kat - ALBME · Kat . Kathy House, MS State Opioid Coordinator . Alabama Department of Mental Health . Mental Health and Substance Abuse Services Division P.O. Box 301410 . Montgomery,

Statement of NeedInformation gleaned from inspections indicate defi ciencies and lack of understanding of the collaborative practice guidelines as they relate to supervision and quality assurance. Therefore, information presented in this seminar will include an overview of the rules for the establishment of a collaborative practice, guidelines on how the practice is to be conducted with regards to supervision and quality assurance, and how to successfully complete Quality Assurance Reviews.

For More InformationContact the Medical Association’s Education Department at (334) 954-2500 or (800) 239-6272 or go to www.alamedical.org/Prescribing.

WHO SHOULD ATTENDThis course is for Physicians, Certifi ed Registered Nurse Practitioners, Certifi ed Nurse Midwives and Physician Assistants in a collaborative practice agreement as well as those interested in developing a collaborative practice agreement.

Dates and DetailsFOUR-HOUR COURSE!Friday, Nov. 22, 20197:30 a.m. – 11:45 a.m.

Location Hyatt Regency Birmingham - The Wynfrey Hotel1000 Riverchase GalleriaBirmingham, AL

Hotel AccommodationsRoom rate: $138 (plus taxes)Room block ends: Oct. 31, 2019Room code: Medical AssociationReservations: Call (800) 233-1234 or reserve a room online at www.hyattregencywynfrey.com

Collaborative and Supervisory

Practices: Pearls, Pitfalls and Protocols

Nov. 22, 2019BirminghamPresented by the Medical Association of the

State of Alabama, the Alabama Board of Medical Examiners, and the Alabama Board of Nursing

Page 4: Kat - ALBME · Kat . Kathy House, MS State Opioid Coordinator . Alabama Department of Mental Health . Mental Health and Substance Abuse Services Division P.O. Box 301410 . Montgomery,

Agenda – Friday, Nov. 22, 20197:00 a.m. Registration and Light Breakfast (Registered attendees only)

7:30 a.m. – 8:30 a.m. Protecting your Patients and your Practice – Policies and Procedures of the Alabama Board of Medical Examiners Beverly F. Jordan, MD | Professional Medical Associates, PC, Enterprise | ALBME*

8:30 a.m. – 9:15 a.m. Protocols and Pitfalls: Part I – Policy Updates from the Alabama Board of Nursing Dawn B. Daniel, MSN, RN | Advanced Practice Nurse Consultant | Alabama Board of Nursing

9:15 a.m. – 9:30 a.m. Break (Registered attendees only)

9:30 a.m. – 10:15 a.m. Protocols and Pitfalls: Part II Procedures and Profi ciencies for Collaborative Practice and Registration Agreements Patricia B. Ward, RN | Collaborative Practice Nurse Consultant, Alabama Board of Medical Examiners Donna Jordan, MPA | Director of Assistants to Physicians | Alabama Board of Medical Examiners

10:15 a.m. – 11:00 a.m. Primary Pitfalls of Controlled Substance Prescribing for Advanced Level Practitioners and the Path to Preventing Problems Amy M. Wybenga, CRNP | Collaborative Practice Nurse Consultant | Alabama Board of Medical Examiners

11:00 a.m. – 11:45 a.m. Panel of All Speakers

11:45 a.m. Evaluation and CME Claim Form (Complete and turn in to receive CME Credit)

Agenda subject to change*Alabama Board of Medical Examiners Board Member

Participant Learning ObjectivesAfter attending this course, participants will be able to: Cite the application, approval, recent rule changes and updates for physicians,

CRNPs and CNMs in a collaborative practice relationship and PAs in registration agreements.

List the eligibility requirements for physicians to become collaborating, supervising or covering physicians.

List the credentials a CRNP, CNM or PA is required to have to enter into a collaborative practice agreement or a registration agreement.

List the responsibilities of both physicians and nurse practitioners in a collaborative practice agreement.

Describe common problems seen in a collaborative practice and methodologies to correct them.

Cite the regulations for prescribing drugs, participating in a quality assurance review and practicing in various practice settings, including remote sites.

Credit Designation The Medical Foundation of Alabama designates this live activity for a maximum of 4 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Medical Association of the State of Alabama through the joint providership of the Medical Foundation of Alabama and the Medical Association of the State of Alabama. The Medical Foundation of Alabama is accredited by the Medical Association of the State of Alabama to provide continuing medical education for physicians.

Visit www.alamedical.org/Prescribing for online registration, brochure and agenda.

19 South Jackson Street | PO Box 1900 | Montgomery, AL 36102-1900 www.alamedical.org

You may also want to register for:Medical EthicsFriday, Nov. 22, 201912:30 p.m. - 5:15 p.m.Prescribing of Controlled DrugsSaturday, Nov. 23, 20197:00 a.m. - 5:15 p.m.Pharmacology of Controlled DrugsSunday, Nov. 24, 20197:00 a.m. - 11:45 a.m.NOTE: On-site registration is not permitted.

Page 5: Kat - ALBME · Kat . Kathy House, MS State Opioid Coordinator . Alabama Department of Mental Health . Mental Health and Substance Abuse Services Division P.O. Box 301410 . Montgomery,

2019

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Page 6: Kat - ALBME · Kat . Kathy House, MS State Opioid Coordinator . Alabama Department of Mental Health . Mental Health and Substance Abuse Services Division P.O. Box 301410 . Montgomery,

Nov. 22, 2019 | Agenda12:30 p.m. Light Lunch (Registered attendees only)

1:00 p.m. – 2:00 p.m. Professionalism in Medicine Brandy A. Boone, JD | Director, Client Education & Guidance | ProAssurance

2:00 p.m. – 3:00 p.m. Evaluating and Treating Physicians Involved in Sexual Misconduct and Sexual Harassment

Paul J. O’Leary, MD | Psychiatrist | SHKO Medicine, LLC, Birmingham

3:00 p.m. – 3:15 p.m. Break (Registered attendees only)

3:15 p.m. – 4:15 p.m. How to Jeopardize Your License: 10 Easy Steps Steven P. Furr, MD | Family Practice of Jackson | Past Member, ALBME*

4:15 p.m. – 5:15 p.m. Ethical Issues: Case Files from the Board of Medical Examiners Steven P. Furr, MD | Family Practice of Jackson | Past Member, ALBME* George C. (Buddy) Smith, Jr. MD | Clay County Medical Clinic, Lineville Past Member, ALBME*

5:15 p.m. Evaluation and CME Claim Form (Complete and turn in to receive CME credit)

Agenda subject to change.*Alabama Board of Medical Examiners Board Member

MedicalMedicalEthicsEthicsPresented by the Medical Association of the State of Alabama and the Alabama Board of Medical Examiners

Page 7: Kat - ALBME · Kat . Kathy House, MS State Opioid Coordinator . Alabama Department of Mental Health . Mental Health and Substance Abuse Services Division P.O. Box 301410 . Montgomery,

Dates and DetailsFOUR-HOUR COURSE!Friday, Nov. 22, 201912:30 p.m. – 5:15 p.m.

Location Hyatt Regency Birmingham - The Wynfrey Hotel1000 Riverchase GalleriaBirmingham, AL

Hotel AccommodationsRoom rate: $138 (plus taxes)Room block ends: Oct. 31, 2019Room code: Medical AssociationReservations: Call (800) 233-1234 or reserve a room online at www.hyattregencywynfrey.com

Statement of NeedThe practice of medicine is governed by important ethical precepts, including confi dentiality, benefi cence, respect for patient autonomy, truth telling and the highest degree of professionalism. Physicians work within the guidelines of these principles; yet medical practice can also be challenged by these principles, particularly when two or more are in confl ict. Medical Ethics – liberally employing case presentations – focuses on applied ethics, from boundary issues to billing practices.

For More InformationContact the Medical Association’s Education Department at (334) 954-2500 or (800) 239-6272 or go to www.alamedical.org/Prescribing.

WHO SHOULD ATTENDThis course is designed for physicians in all specialties who wish or need to pursue focused study in areas of applied ethics, including boundary maintenance and practice management.

MedicalMedicalEthicsEthicsPresented by the Medical Association of the State of Alabama and the Alabama Board of Medical Examiners

Page 8: Kat - ALBME · Kat . Kathy House, MS State Opioid Coordinator . Alabama Department of Mental Health . Mental Health and Substance Abuse Services Division P.O. Box 301410 . Montgomery,

Agenda – Friday, Nov. 22, 201912:30 p.m. Light Lunch (Registered attendees only)

1:00 p.m. – 2:00 p.m. Professionalism in Medicine Brandy A. Boone, JD | Director, Client Education & Guidance | ProAssurance

2:00 p.m. – 3:00 p.m. Evaluating and Treating Physicians Involved in Sexual Misconduct and Sexual Harassment Paul J. O’Leary, MD | Psychiatrist | SHKO Medicine, LLC, Birmingham

3:00 p.m. – 3:15 p.m. Break (Registered attendees only)

3:15 p.m. – 4:15 p.m. How to Jeopardize Your License: 10 Easy Steps Steven P. Furr, MD | Family Practice of Jackson | Past Member, ALBME*

4:15 p.m. – 5:15 p.m. Ethical Issues: Case Files from the Board of Medical Examiners Steven P. Furr, MD | Family Practice of Jackson | Past Member, ALBME* George C. (Buddy) Smith Jr., MD | Clay County Medical Clinic, Lineville | Past Member, ALBME*

5:15 p.m. Evaluation and CME Claim Form (Complete and turn in to receive CME credit)

Agenda subject to change.*Alabama Board of Medical Examiners Board Member

Participant Learning ObjectivesAfter attending this course, participants will be able to: Describe the meaning and importance of medical professionalism. Discuss how confl ict of interest may compromise professionalism. Identify signifi cant boundary issues and proper limits in relation to

each. Discuss exceptions to the principles of confi dentiality. Describe important ethical issues with respect to operating a

practice. List elements that help to distinguish between “Usual and

Customary” and Healthcare Fraud. Describe errors physicians frequently commit with regard to

informed consent.

Credit DesignationThe Medical Association of the State of Alabama designates this live activity for a maximum of 4 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Accreditation This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Medical Association of the State of Alabama through the joint providership of the Medical Foundation of Alabama and the Medical Association of the State of Alabama. The Medical Foundation of Alabama is accredited by the Medical Association of the State of Alabama to provide continuing medical education for physicians.

Visit www.alamedical.org/Prescribing for online registration, brochure and agenda.19 South Jackson StreetPO Box 1900Montgomery, AL 36102-1900www.alamedical.org

You may also want to register for:Collaborative and Supervisory Practices: Pearls, Pitfalls and ProtocolsFriday, Nov. 22, 20197:00 a.m. - 11:45 a.m.Prescribing of Controlled DrugsSaturday, Nov. 23, 20197:00 a.m. - 5:15 p.m.Pharmacology of Controlled DrugsSunday, Nov. 24, 20197:00 a.m. - 11:45 a.m.NOTE: On-site registration is not permitted.

19 South Jackson Street | PO Box 1900 | Montgomery, AL 36102-1900 www.alamedical.org

Page 9: Kat - ALBME · Kat . Kathy House, MS State Opioid Coordinator . Alabama Department of Mental Health . Mental Health and Substance Abuse Services Division P.O. Box 301410 . Montgomery,

2019

REG

ISTR

ATIO

NC

olla

bora

tive

and

Supe

rviso

ry P

ract

ices

: Pea

rls, P

itfal

ls an

d Pr

otoc

ols

M

edic

al E

thic

s |

Pres

crib

ing

of C

ontro

lled

Drug

s |

Phar

mac

olog

y of

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trolle

d Dr

ugs

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019

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d C

ME

cred

its?

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ster

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ll fou

r cou

rses

to e

arn

20 A

MA

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Cat

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y 1

Cre

dits

™. A

ll reg

istra

tion

fees

mus

t be

paid

at t

he ti

me

of re

gist

ratio

n. O

n-sit

e re

gist

ratio

n is

not p

erm

itted

. A 5

0% re

fund

will

be g

iven

for c

ance

llatio

n m

ade

by N

ov. 8

. Can

cella

tion

of a

cou

rse

mus

t be

subm

itted

in w

ritin

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n De

partm

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stra

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Page 10: Kat - ALBME · Kat . Kathy House, MS State Opioid Coordinator . Alabama Department of Mental Health . Mental Health and Substance Abuse Services Division P.O. Box 301410 . Montgomery,

Statement of NeedControlled substances are prescribed and dispensed today at an increasing rate to help patients cope with pain, insomnia, anxiety, depression, ADHD and a myriad other disorders. Studies show that most practitioners are rather conservative when prescribing controlled drugs, while a small number are at times overly aggressive. In addition, controlled substance medications are falling into the hands of increasing numbers of prescription drug abusers.

How can the practitioner more effectively understand the

criteria for appropriate prescribing and consider the therapeutic

This special intensive course has been developed to enhance the physician’s ability to effectively prescribe controlled medications, while minimizing their misuse whenever possible.

For More InformationContact the Medical Association’s Education Department at (334) 954-2500 or (800) 239-6272 or go to www.alamedical.org/Prescribing.

2019 SeriesINTENSIVE COURSE INPrescribing and Pharmacology of Controlled Drugs: Critical Issues and Common PitfallsPresented by the Medical Association of the State of Alabama,the Alabama Board of Medical Examinersand the Alabama Board of Nursing

WHO SHOULD ATTENDThe course in Prescribing and Pharmacology of Controlled Drugs is designed for physicians in all

registered nurse practitioners and nurse midwives, who need or wish to increase their knowledge and ability to effectively prescribe controlled medications that have the potential for misuse and abuse.

DATES AND ACCOMMODATIONSMarch 2-3Meeting Location:

Edward Via College of Osteopathic Medicine (VCOM)910 S. Donahue Drive | Auburn, Ala.

Accommodations:Auburn University Hotel & Conference Center241 S. College Street | Auburn, Ala.

Room Rate: $159 (plus applicable taxes)Room Block Deadline: February 10, 2019Room Block Code: MASA PrescribingHotel Reservations: (800) 228-2876 or www.auhcc.com

August 2-4 (4 hours each day)Sandestin Golf & Beach Resort9300 Emerald Coast Parkway W. | Destin, Fla.Room Rate: $255-$509 (plus applicable taxes)Room Block Deadline: June 30, 2019Room Block Code: 23Z0QUReservations: (800) 320-8115 or www.sandestin.com

November 23-24Hyatt Regency Birmingham-The Wynfrey Hotel1000 Riverchase Galleria | Birmingham, Ala.Room Rate: $138 (plus applicable taxes)Room Block Deadline: October 31, 2019Room Block Code: Medical AssocReservations: (800) 233-1234, (205) 705-1234 or www.hyattregencywynfrey.com

And on November 22...• Collaborative and Supervisory Practices:

Pearls, Pitfalls and Protocols• Medical EthicsHyatt Regency Birmingham-The Wynfrey Hotel

Page 11: Kat - ALBME · Kat . Kathy House, MS State Opioid Coordinator . Alabama Department of Mental Health . Mental Health and Substance Abuse Services Division P.O. Box 301410 . Montgomery,

Participant Learning Objectives After attending this course, participants will be able to:

Identify the diagnostic criteria for acute and chronic pain, anxiety disorder, insomnia, depression and substance abuse. Employ interviewing techniques relating to the diagnosis and management of substance abuse in general and

prescription drug abusers in particular. Discuss case management strategies for the above diagnoses and in special situations, such as the elderly, hospice

Discuss beliefs, attitudes and stereotypes about controlled substance prescribing, controlled drug abusers and chemical dependency, and consider the therapeutic implications of treatments based upon these beliefs.

NEW Topics!

Current Thoughts on Marijuana Use

Credit DesignationThe Medical Association of the State of Alabama designates this live activity for a maximum of 12 AMA PRA Category 1 Creditstheir participation in the activity.

AccreditationThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Medical Association of the State of Alabama through the joint providership of the Medical Foundation of Alabama and the Medical Association of the State of Alabama. The Medical Foundation of Alabama is accredited by the Medical Association of the State of Alabama to provide continuing medical education for physicians.

ABN CE Designation• The Medical Association of the State of Alabama, an ABN-recognized provider of continuing education (CE), awards AMA PRA Category 1 Credits™

upon completion of this course. ABN Administrative Code § 610-X-10-.04(2)(e)

• Nurses who wish to claim the credit awarded for this course must follow ABN procedures to claim the CE, such as uploading the CME transcript issued by the Medical Association to their individual CE Record on the ABN website.

19 South Jackson Street PO Box 1900 Montgomery, AL 36102-1900 www.alamedical.org

Visit www.alamedical.org/Prescribing for online registration and agenda.

Gregory W. Ayers, M.D. Birmingham Hospitalists, P.C.ALBME*

Daniel M. Doleys, PhDThe Doleys Clinic/Pain and Rehabilitation Institute

Stanley R. (Randy) Easterling, M.D.Pathway HealthcareVicksburg, MS

J. Luke Engeriser, M.D. Altapointe Health Systems

Sandra L. Frazier, M.D.Department of Medical EducationUniversity of Alabama Birmingham

Steven P. Furr, M.D.Family Practice of JacksonPast Member, ALBME*

Boyde J. (Jerry) Harrison, M.D.Private Practice, HaleyvilleALBME*

David P. Herrick, M.D.The Center for Pain, P.C.Past Member, ALBME*

Virginia B. Reeves, JDAssociate General CouncilALBME*

George C. (Buddy) Smith Jr., M.D.Clay County Medical Clinic, P.C.Past Member, ALBME*

Randall L. Tackett, Ph.D.Professor, Graduate CoordinatorUniversity of Georgia College of Pharmacy

Richard TuckerDrug Education Consulting GroupFormer U.S. DEA Special Agent

J. Mark Westfall, M.D.Westfall Psychiatric Services

*Alabama Board of Medical Examiners

Faculty

NEW!of Controlled Drugs course meets the requirements for physicians who hold an ACSC and must now obtain, every two years, 2 AMA PRA Category 1 CreditsTM in the areas of controlled substances prescribing practices, recognizing signs of the abuse or misuse of controlled substances, or controlled substance prescribing for chronic pain as set forth by the Alabama Board of Medical Examiners effective Jan. 1, 2018.

Course Meets NewBME CME Rule

Page 12: Kat - ALBME · Kat . Kathy House, MS State Opioid Coordinator . Alabama Department of Mental Health . Mental Health and Substance Abuse Services Division P.O. Box 301410 . Montgomery,

2019 REGISTRATIONIntensive Course in Prescribing and Pharmacology of Controlled Drugs

The registration fee for the 12-hour Prescribing and Pharmacology course is $400. The 8-hour Prescribing course is $275 and the 4-hour Pharmacology course is $125. A 50% refund will be given for cancellation made by February 15 (for March course), July 19 (for August course) and November 8 (for November course). Cancellation of a course must be submitted in writing to the Education Department. Registrations cannot be transferred to future Prescribing and Pharmacology courses. No refunds for cancellations the week of each course.

EACH ATTENDEE MUST COMPLETE A SEPARATE REGISTRATION FORM.

Name: _______________________________________________________________________________ MD DO PA CRNP CNM Other _______________

Practice/Company: __________________________________________________________________ Nursing License Number: ____________________________________

Address: ______________________________________________________________________City, State, Zip: _____________________________________________________

Phone: ___________________________________________ Fax: _____________________________________________ E-mail: _______________________________________

Dietary and other Special Considerations: __________________________________________________________________________________________________________

Courses and Registration Fees All registration fees must be paid at the time of registration. On-site registration is not permitted.

Return completed registration form and payment to:Medical Foundation of Alabama | 19 S Jackson Street| Montgomery, AL 36104 | Phone (334) 954-2500 | Fax (334) 269-5200 | alamedical.org

Check (Make payable to Medical Foundation of Alabama) Amount: $_____________ American Express Discover MasterCard VISA Amount: $_____________

Cardholder Name: _________________________________________________________________________ Card Number: ________________________________________________________

Street Address: _____________________________________________________________________________ City, State, Zip: ________________________________________________________

Exp. Date: ______________________________________Security Code: _____________________________ Signature: ____________________________________________________________

Payment Note: Your signature constitutes an agreement to pay the amount indicated.

March Course (Mark all you wish to attend) Fees*Prescribing of Controlled Drugs (8 hours) ...................................... $275

Saturday | March 2

Pharmacology of Controlled Drugs (4 hours) ............................... $125 Sunday | March 3*Fees before February 15 | After February 15 add $50 per course

August Course (Mark all you wish to attend) Fees**Prescribing of Controlled Drugs (8 hours) ...................................... $275

Friday and Saturday | August 2-3

Pharmacology of Controlled Drugs (4 hours) ...............................$125 Sunday | August 4**Fees before July 19 | After July 19 add $50 per course

November Course (Mark all you wish to attend) Fees***Collaborative and Supervisory Practices (4 hours) ....................... $125

Friday morning | November 22

Medical Ethics (4 hours) .................................................................... $125 Friday afternoon | November 22

Prescribing of Controlled Drugs (8 hours) ....................................... $275 Saturday | November 23

Pharmacology of Controlled Drugs (4 hours) ................................ $125 Sunday| November 24***Fees before November 8 | After November 8 add $50 per course