ASIPP® EDUCATIONAL SERVICES | EXCELLENCE IN THE … · 10:00 am – 12:00 pm Ultrasound Hands on Workshop: Upper Extremity Viviane Khoury, MD, Sheldon Jordan, MD, Sheri Albers, DO,

ULTRASOUNDALL DAY, LIVE MODEL, HANDS-ON WORKSHOP7.75 AMA PRA Category 1 Credits™

FEBRUARY 21, 2019 | ORLANDO, FLVENUEDOUBLETREE BY HILTON ORLANDO DOWNTOWN60 South Ivanhoe Blvd, Orlando, FL 32804Phone: 407-425-4455

SPECIALS• Special room rates through January 29, 2019 • Approximately 80% off course fee for Resident/Fellows

THIS COURSE IS OPEN TO PHYSICIANS ONLY

American Society of Interventional Pain PhysiciansTHE VOICE OF INTERVENTIONAL PAIN MANAGEMENTA

ASIPP® EDUCATIONAL SERVICES | EXCELLENCE IN THE EDUCATION OF INTERVENTIONAL PAIN PHYSICIANS

American Society of Interventional Pain Physicians2

ULTRASOUND ALL DAY, LIVE MODEL, HANDS-ON WORKSHOPFEBRUARY 21, 2019 | ORLANDO, FLORIDA

YOU’RE INVITED On behalf of the Board of the American Society of Interventional Pain

Physicians (ASIPP®), it is our privilege and pleasure to invite you to attend this

Ultrasound, all day, live model, hands-on workshop. The workshop will be held

for one day February 21, at the DoubleTree by Hilton Orlando Downtown. This

course meets the needs of interventionalists.

EDUCATIONAL OBJECTIVES/TARGET AUDIENCEThis Ultrasound Workshop is targeted to interventional pain physicians seeking CME credit hours and an introduction or review of proven interventional techniques, as well as skills improvement.

EDUCATIONAL OBJECTIVES • Provide high-quality, competent, safe, accessible, and cost-efficient services to your patients• Improve existing skills and/or develop new skills in the delivery of Ultrasound Workshop• Incorporate interventional techniques in treating your patients so that patients have better outcomes and reduced side effects

AMERICANS WITH DISABILITIES ACT AND SPECIAL SERVICESOrganizers fully comply with the legal requirements of the Americans with Disabilities Act and the rules and regulations thereof. If any participant in this educational activity is in need of accommodations, please contact the organizers at (270) 554-9412 at least 10 days prior to the conference.

ACCREDITATION STATEMENTThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of The Institute for Medical Studies and the American Society of Interventional Pain Physicians (ASIPP®). The Institute for Medical Studies is accredited by the ACCME to provide continuing medical education for physicians.

CATEGORY I CREDITThe Institute for Medical Studies designates the Ultrasound Workshop live activity for a maximum of 7.75 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

ASIPP® is now an ABA Registered CME Provider.

DUPLICATION OR DISTRIBUTION OF MATERIALS OR RECORDING OF LECTURES WITHOUT EXPRESS WRITTEN PERMISSION FROM ASIPP® IS PROHIBITED. THERE IS NO COMMERCIAL SUPPORT FOR THIS COURSE.

Laxmaiah Manchikanti, MDChairman of the Board and Chief Executive Officer, ASIPP®

Sheri L. Albers, DODirector at Large, ASIPP®

Sheldon Jordan, MDNeurologist, Facial Pain Center

GUEST SPEAKERViviane Khoury, MD Assistant Professor of RadiologyDivision of Musculoskeletal ImagingDirector, Musculoskeletal Ultrasound University of Pennsylvania

FACULTYSheri Albers, DO Sacramento, CA Joseph Cabaret, MD Camarillo, CA Miguel Pappolla, MD Houston, TX Kent Remley, MD Newnan, GA Douglas Spiel, MD Edison, NJ Art Watanabe, MD Bellingham, WA

COURSEDIRECTORS

ACCOMMODATIONS DOUBLETREE BY HILTON HOTEL ORLANDO DOWNTOWN60 South Ivanhoe Boulevard, Orlando, Florida, 32804, USA P: 407-425-4455 | F: 407-425-7440 DoubleTree by Hilton hotel near Amway Center offers stylish guest rooms and comforting amenities. Enjoy the signature chocolate chip cookie, and know that this welcoming gift is only a taste of the warm, personal service you will experience at downtown Orlando hotel.In order to ensure you receive the ASIPP room block rate of $129 per night let the hotel know you are with the ASIPP Meeting. The room block deadline is January 29, 2019.

American Society of Interventional Pain Physicians 3

ULTRASOUND ALL DAY, LIVE MODEL, HANDS-ON WORKSHOPFEBRUARY 21, 2019 | ORLANDO, FLORIDA

THURSDAY, FEBRUARY 21, 2019 COMPREHENSIVE REVIEW COURSE FOR UTRASOUND

8:00 am – 8:05 am Introduction to Ultrasound Sheri Albers, DO

8:05 am – 8:15 am US guided injections for nerve pathology Sheldon Jordan, MD

Introduction to MSK US: Live Model demonstration: techniques for Viviane Khoury MD joint imaging with presentation of normal Sheri Albers DO ultrasonographic findings covering: tendons, muscles, neural structures, bursae, bone and joint space, artifacts

8:15 am - 8:45am Shoulder US:

8:45am – 9:00 am Elbow US

9:00 am – 9:20 am Wrist US

9:20 am – 9:35 am Hip US

9:35 am – 10:00 am BREAK

10:00 am – 12:00 pm Ultrasound Hands on Workshop: Upper Extremity Viviane Khoury, MD, Sheldon Jordan, MD, Sheri Albers, DO, Kenneth Candido, MD, Miguel Pappolla, MD

12:00 pm – 1:00 pm SPONSORED LUNCH “Understanding Legal Tools: Keys to Locking out Lawsuits, Tax Reduction and License Protection” (non-cme lecture sponsored by Legally Mine, Inc.) Leland McKay, Legally Mine, Inc.

1:00 pm – 3:30 pm Ultrasound Hands on Workshop: Lower Extremity Viviane Khoury, MD, Sheldon Jordan, MD, Sheri Albers, DO, Kenneth Candido, MD, Miguel Pappolla, MD

3:30 pm – 4:00 pm BREAK

4:00 pm – 4:30 pm What’s Wrong with My Shoulder? Common US pathology of the Shoulder (Lecture) Viviane Khoury MD

4:30pm – 4:45 pm Normal Knee: Live Model Presentation (Demonstration) Sheri Albers DO

4:45 pm – 5:15 pm Normal Ankle: Live Model Presentation (Demonstration) Viviane Khoury MD

5:15 pm – 5:45 pm The Painful Ankle: Can you help? Common US pathology of the Ankle (Lecture) Viviane Khoury MD

American Society of Interventional Pain Physicians4

ULTRASOUND ALL DAY, LIVE MODEL, HANDS-ON WORKSHOPFEBRUARY 21, 2019 | ORLANDO, FLORIDA

REGISTRANT INFORMATIONIMPORTANT. Please answer all the questions:

MEDICAL DEGREE:m MD m DO m PhDm List other: ____________________________

PRIMARY SPECIALTY CERTIFICATION:m Anesthesiology m Physiatrym Neurosurgery m Other: _______________________________

PAIN MEDICINE SUBSPECIALTY CERTIFICATION:m ABMS Pain Medicine (Anesthesiology, PMR, Neurology, Psychiatry, Emergency Medicine)m American Board of Pain Medicinem American Board of Interventional Pain Physiciansm Fellow of Interventional Pain Practice (FIPP)

FELLOWSHIP TRAINING: mPain Medicine m Spine Surgery m Sports Medicinem Other: ______________________________________

SPECIALTY DESIGNATION:m 09 - Interventional Pain Managementm 72 - Pain Managementm Other: ______________________________________

WHAT IS YOUR PRACTICE LOCATION:m ASC m HOPD m Office-setting

PERCENTAGE OF INTERVENTIONAL PAIN MANAGEMENT PRACTICE:m 0% m 1-25% m 26-50% m 51-75% m > 75%

YEARS IN INTERVENTIONAL PAIN MANAGEMENT PRACTICE:m 0 m 1-5 m 6-10 m > 10

TOTAL NUMBER OF PROCEDURES PERFORMED DURING PAST YEAR:

PROCEDURE TOTAL PERFORMED

Soft Tissue and Ligament Injections ___________

Shoulder Injections ___________

Elbow Injections ___________

Wrist Injections ___________

Hip Injections ___________

Knee Injections ___________

Ankle Injections ___________

Sacroiliac Joint Injections ___________

Caudal Epidural Injections ___________

Lumbar Interlaminar Epidural Injections ___________

Lumbar/Sacral Transforaminal Epidural Injections ___________

Lumbar/Sacral Facet Joint Nerve Blocks ___________

Lumbar Facet Joint Intraarticular Injections ___________

Lumbar Discography ___________

Pudendal Nerve Blocks ___________

Ultrasound Guided Injections ___________

REGISTRATION PLEASE PRINT EXACTLY AS YOU WISH YOUR NAME TO APPEAR:

___________________________________________________________________________________________________NAME (FIRST) (MIDDLE INITIAL) (LAST)

_________________________________________________________________________________________ORGANIZATION

_________________________________________________________________________________________ADDRESS

_________________________________________________________________________________________CITY STATE ZIP

_________________________________________________________________________________________PHONE FAX

_________________________________________________________________________________________E-MAIL

* If registering as a Resident or Fellow, please list below the name of fellowship program, university or hospital and fax or e-mail a letter from the program director verifying your status. Your application for registration cannot be processed and you will not receive the discount until ASIPP receives this letter. Fax the letter to 270-554-5394 or e-mail to [email protected]

________________________________________________________________________________________NAME OF FELLOWSHIP PROGRAM

PAYMENT METHOD (Please check one):m MASTERCARD m VISA m AMERICAN EXPRESS m DISCOVER

________________________________________________________________________________________CREDIT CARD NUMBER SECURITY CODE (Back of Card) EXP. DATE

________________________________________________________________________________________NAME ON CARD

________________________________________________________________________________________AUTHORIZED SIGNATURE (required on all credit card orders)

(Your application will not be processed if payment does not accompany registration form)

RETURN COMPLETED FORM TO:ASIPP®, 81 Lakeview Drive, Paducah, KY 42001 or Fax to 270-554-5394

CANCELLATION POLICY:ASIPP® reserves the right to cancel this course upon reasonable notice and will assume no financial obligation to registrants for cancellation for reasons beyond its control. Registration fees will be refunded, however, costs incurred by the registrants, such as airline or hotel fees or penalties, are the responsibility of the registrants. ASIPP requires a 30-day notice of cancellation. Cancellations must be submitted in writing by January 23, 2019. Cancellations after January 23, 2019 but prior to February 8, 2019 will forfeit 50% of their registration fee. No refunds can be made after February 8, 2019.

REGISTER ONLINE AT http://www.asipp.org/ASIPP-National-Meetings.html

ULTRASOUNDALL DAY, LIVE MODEL, HANDS-ON WORKSHOPAll registrations must be approved

ULTRASOUND WORKSHOPm $1,000 Member m $1,400 Non-Memberm $ 300 Fellow/Resident *

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