The Family Medicine Foundation - 30th Annual... · November 10 - 13, 2016 CONFERENCE ACCREDITATION thThis live activity, the 30 Annual José I. Ricard, MD Family Medicine & Sports

Family Medicine Foundation of West Virginia 30

th ANNUAL JOSÉ I. RICARD, MD

FAMILY MEDICINE & SPORTS MEDICINE CONFERENCE

Pullman Plaza Hotel - Huntington, West Virginia

November 10 - 13, 2016

CONFERENCE ACCREDITATION

This live activity, the 30th Annual José I. Ricard, MD Family

Medicine & Sports Medicine Conference, with a beginning date of

11/10/2016, has been reviewed and is acceptable for up to 26.50

Prescribed credit(s) by the American Academy of Family

Physicians. Physicians should claim only the credit commensurate

with the extent of their participation in the activity. AAFP Prescribed

credit is accepted by the American Medical Association as

equivalent to AMA PRA Category 1 for the AMA Physicians

Recognition Award. When applying for AMA PRA, Prescribed hours,

earned must be reported as Prescribed hours, not Category 1.

Approved for 26.50 hours of continuing education (which includes 15

hours of pharmacology) by the American Nurses Credentialing

Center (ANCC) / West Virginia Nurses Association (PENDING)

This program was planned in accordance with AANP CE Standards

and Policies and AANP Commercial Support Standards.

This program is approved for 26.50 credits of AOA Category 2-A

continuing education by the American Osteopathic Association.

This program is accepted for Physician Assistant CE credit.

This program is approved by the West Virginia Board of Examiners

for Registered Professional Nurses. Provider # WV1996-0101RN.

The Sunday program is approved for 7.25 hours of continuing

education by the West Virginia Board of Chiropractic (PENDING).

This program is approved for 26.50 contact hours by the West

Virginia Board of Physical Therapy. Approval # FMF-F16-01. Approval of this course does not necessarily imply that the West Virginia

Board of Physical Therapy supports the views of the presenter or sponsor.

Approved for 26.50 Category-1 contact hours by the Kentucky

Physical Therapy Association Approval #35-16-IPKPTA.

Approved for 26.50 General Hours of CPE credit by the West Virginia

Board of Pharmacy (PENDING).

Recognized by the Board of Certification, Inc. to offer continuing

education for Certified Athletic Trainers. This program has been

approved for 26.50 hours of Evidence Based Practice (EBP) Category

continuing education. Certified Athletic

Trainers are responsible for claiming only

those hours actually spent participating in

the continuing education activity.

BOC Approved EBP Provider # P657-2005

SPONSORS: Family Medicine Foundation of West Virginia,

Marshall University’s Joan C. Edwards School of Medicine,

Marshall Health - Family Medicine, Division of Sports Medicine

COURSE DESCRIPTION: The educational topics included in

this Conference will include the following:

Drug Diversion Training and Best Practice Prescribing

of Controlled Substances (Thursday, November 10)

Peripheral Arterial Disease (Friday, November 11)

Dermoscopy in Primary Care

Diabetes in Appalachia

Infectious Disease Prevention - Harm Reduction Program

Keeping the Elderly Active and at Home

West Virginia Medicaid Managed Care

Transcatheter Aortic Valve Replacement

Safe and Responsible Prescribing – DEA Perspective

Medication Assisted Treatment (Saturday, November 12)

Fueling Young Athletes: Separating Sense from Nonsense

Tobacco Control in West Virginia

Advance Directives

Eye/Eyelids: Relations/Inter-Relations in

Selected Disease States

Lipid Disorders

Celiac Disease and Gluten Sensitivity

Depression/Anxiety

PTSD/Suicide Prevention

Exercise Prescription for Child and Adolescent

Mental Health (Sunday, November 13)

Psychosocial Screening Recommendations for

Athletes and Injury Prevention

Responding to Catastrophic Events in Sports

Pre Participation Exams

Preventing Arm Injuries in Baseball

Common Vascular Compromise Conditions

Selective Joint Injection Techniques

CONFERENCE OBJECTIVE: To provide regional health

care professionals with an update on the diagnosis and treatment of

commonly encountered medical problems. Conference attendees

will acquire practical, clinical information helpful in the diagnosis,

treatment, and management of medical problems, and enhance and

advance knowledge, skills, and professional performance,

furthering excellence in health care.

4 WAYS TO REGISTER TODAY!

Online

WWW.FMFWV.ORG

Phone

(304) 733 – 6485

Mail

Complete the Registration Form and mail to

650 Main Street

Barboursville, WV 25504

Fax

Complete the Registration Form and fax to

(304) 733 – 6486

PRE-CONFERENCE WORKSHOP Thursday, November 10, 2016

“Drug Diversion Training and Best Practice

Prescribing of Controlled Substances”

Please join the Family Medicine Foundation of West

Virginia for a 3-hour “Drug Diversion Training and Best

Practice Prescribing of Controlled Substances” lecture, to

be held on Thursday, November 10, 2016, from 6:00 pm –

9:15 pm at the Pullman Plaza Hotel in Huntington, WV.

Our lecturers will be Jeannie Sperry, PhD, ABPP, health

psychologist at the Pain Rehabilitation Center at the Mayo

Clinic in Rochester, MN and Alison Vargovich, PhD,

Clinical Psychologist with the West Virginia University

Department of Family Medicine in Morgantown, WV.

This lecture will satisfy the continuing education

requirements set forth by the West Virginia Legislature and

appropriate licensing boards for MDs, DOs, NPs, PAs, RNs,

LPNs, and pharmacists. This program is required for each

West Virginia licensee who “prescribes, administers, or

dispenses a controlled substance.” The cost of lecture is

$95.00. Please RSVP; light dinner included.

LEARNING OBJECTIVES (including, but not limited to):

Drug diversion, including West Virginia statistics on

prescription drug abuse, misuse, and resulting deaths;

Epidemiology of chronic pain and misuse of opioids;

Indications for opioids in chronic pain treatment, including

general characteristics, toxicities, and drug interactions;

Initiation/ongoing management of chronic pain patients,

including treatment objectives/functional goals, monitoring

and periodic review, referrals, consultations, informed

consent, prescribing agreements, urine screens, pill counts,

patient education on safe use and storage/disposal of

opioids, discontinuation/termination due to lack of benefits

or increased risks, and documentation/medical records;

Examination of patient evaluation and risk assessment and

related tools, with proper usage/administration of

Naloxone;

Identification of diversion/drug seeking tactics/behaviors;

Best practice methods for working with drug seeking

patients and diversion, including new online resources;

Compliance with controlled substances laws and rules;

Registration with and use of the West Virginia Controlled

Substances Monitoring Program established in WV Code

Chapter 60A, Article 9;

Case study of a patient with chronic pain; and

Compliance with state and federal laws.

MORNING SESSION

Friday, November 11, 2016

7:00am Complimentary Blood Drawing /

Chemistry Profile

2nd

Floor, Upper Mezzanine Area

Courtesy of CAMC LabWorks

7:00 Registration/Breakfast/Exhibit Visitation – 2nd

Floor

7:50 “Welcome & Conference Overview”

Robert B. Walker, MD, MS

Program Chairman /

Vice Chancellor for Health Sciences

Higher Education Policy Commission

7:55 “Overview of Morning Topics”

Moderator – Freddie Vaughan, MD

Family Practice Resident

Marshall University

Joan C. Edwards School of Medicine

Huntington, WV

FMFWV Fact: Peripheral arterial disease allows plaque to

build up in the arteries that carry blood to your head, organs,

and limbs. Over time, plaque can harden and narrow the

arteries, limiting the flow of oxygen-rich blood to organs and

other parts of the body.

8:00 “Peripheral Arterial Disease –

Guidelines and Beyond”

Mehiar El-Hamdani, MD

Huntington, WV

FMFWV Fact: Dermoscopy can act as an aid in the

diagnosis of skin lesions, which can reduce unnecessary

referrals and skin surgeries.

8:50 “Dermoscopy in Primary Care”

Josh Cusick-Lewis, MD, MPH

Charleston, WV

9:40 Refreshment Break/Exhibit Visitation – 2nd

Floor

MORNING SESSION


FMWV Fact: 12% of West Virginia adults (240,000+)

have been diagnosed with diabetes, and also experience

higher prevalence of co-morbid conditions. Diabetes in

65,000+ West Virginians remains undiagnosed.

10:00am “Diabetes in Appalachia”

Frank Schwartz, MD

Athens, OH

FMFWV Fact: the Cabell-Huntington Health Department’s

Harm Reduction Program is West Virginia’s first syringe

exchange program, and is expanding rapidly.

10:50 “Infectious Disease Prevention Through

Harm Reduction Programs”

Michael Kilkenny, MD

Heather Wood, CFNP

Huntington, WV

12:05 Lunch Buffet/Exhibit Visitation – 2nd

Floor

AFTERNOON SESSION


12:45pm “Welcome”

Steve Williams

Mayor of Huntington, WV

12:50 “Overview of Afternoon Topics”

Moderator – Anthony Toparis, DO

Family Practice Resident

Charleston Division

West Virginia University Family Medicine

Charleston, WV

FMFWV Fact: West Virginia has one of the oldest

populations in the nation, with more than 16% of its

residents over age 65.

1:00 “Keeping the Elderly Active and at Home”

Cindy Pinson, MD

Huntington, WV

FMFWV Fact: Almost 80% of the West Virginia Medicaid

population has now been integrated into managed care. Over

500,000 West Virginians now receive benefits under

Medicaid and/or CHIP.

1:50 "West Virginia Medicaid Managed Care"

Jeremiah Samples

Charleston, WV

Thanks to our managed care sponsors:

AFTERNOON SESSION


FMFWV Fact: TAVR is a minimally invasive surgical

procedure which repairs a heart valve without removing the

old, damaged valve, especially in patients with an

unacceptably high estimated surgical risk.

2:40pm “Transcatheter Aortic Valve Replacement”

Daniel Snavely, MD

Huntington, WV


Floor

FMFWV Fact: West Virginia has some of the highest rates

of prescription drug abuse and some of the most per capita

overdoses and prescription drug abuse deaths in the nation.

3:50 “Safe and Responsible Prescribing –

DEA Perspective”

Robert Otero

Charleston, WV

5:30 Audience Question & Answer Session

5:45 Adjournment

Friday Night Reception

In loving memory of Dr. José I. Ricard

6:00 pm – 8:00 pm (by reservation – 200 guests)

Featuring Entertainment

Sponsored by:

MORNING SESSION

Saturday, November 12, 2016

7:00am Complimentary Blood Drawing/

Chemistry Profile

2nd




Floor

7:50 “Welcome”

Stephen Petrany, MD

Chairman, Family Medicine

Marshall Health

Huntington, WV


Moderator – Brenden Cooper, MD

Family Practice Resident Wheeling Family Practice Residency Program

Wheeling, WV

FMFWV Fact: Medication Assisted Treatment combines

medications with behavioral therapy to treat substance use

disorders.

8:00 “Medication Assisted Treatment”

Zach Hansen, MD

Huntington, WV

FMFWV Fact: Energy drinks often contain large doses of

caffeine and other legal stimulants like guarana (caffeine

equivalent) and ginseng, as well as artificial sweeteners.

8:50 “Fueling Young Athletes:

Separating Sense from Nonsense”

Christine Rosenbloom, PhD, RDN

Hartwell, GA


Floor

MORNING SESSION


FMFWV Fact: Almost 30% of West Virginia adults and

20% of high school students smoke cigarettes. 18.3 million

U.S. middle and high school students were exposed to

e-cigarette advertising in the past year.

10:00 “Tobacco Control in West Virginia”

Jennifer Pearson, PhD, MPH

Washington, D.C.

FMFWV Fact: It is common for health care providers to

discuss advance directives and other end-of-life concerns

with patients during routine checkups.

10:50 “Advance Directives”

David Myerberg, MD, JD

Morgantown, WV

12:05 Lunch Buffet/Exhibit Visitation – 2nd

Floor

ESP SCHOLARSHIP FUND The Educational Seed for Physicians (ESP) Fund is a medical

student scholarship program designed to help and encourage family

physicians to practice in West Virginia. The fund originated in

1978-1980, when the nearly 15,000 members of the West Virginia

Federation of Women’s Clubs raised over $60,000 for ESP. On

May 1, 1991, the ESP Fund was transferred to the Family Medicine

Foundation of West Virginia.

TULLY SCHOLARSHIP FUND The Dr. C. Carl & Margaret Tully Medical Student Fund was

created from a Charitable Remainder Unitrust established by the

Tullys. It is governed by the Family Medicine Foundation of West

Virginia Board, with a Tully Fund Selection Committee composed

of representatives from the Foundation Board, GFWC West

Virginia, medical schools, and the medical profession.

These two scholarship programs have awarded

$700,000 to 56 physicians over the past 36 years. If

you would like to donate to either fund, please visit

the registration desk on the 2nd

floor.

AFTERNOON SESSION


12:55 pm “Overview of Afternoon Topics”

Moderator – TBD

Family Practice Resident Clarksburg Family Practice Residency Program

Clarksburg, WV

FMFWV Fact: Blindness or low vision affects more than 3

million Americans 40 years and older, and this number is

projected to reach 5.5 million by 2020.

1:00 "The Eye and Eyelids: Relations and Inter-

Relations in Selected Disease States”

Rene Rodriguez-Sains, MD, FACS, PC

Huntington, WV

FMFWV Fact: Cardiovascular Disease is a leading cause

of death for both men and women in West Virginia.

1:50 “Lipid Disorders”

Ramakrishnan Iyer, MBBS, FNLA

Charleston, WV

FMFWV Fact: Celiac Disease is an autoimmune disorder

that can occur in genetically predisposed people where the

ingestion of gluten leads to damage in the small intestine. It

is estimated to affect one in 100 people worldwide.

2:40 "Celiac Disease and Gluten Sensitivity"

Peter H.R. Green, MD

New York, NY


Floor

AFTERNOON SESSION


Veteran Mental Health Symposium

New licensees or license renewals for RNs, LPNs, APRNs,

nurse midwives, chiropractors, psychologists, social workers,

and professional counselors are required to complete two (2)

hours of continuing education for each reporting period on

mental health conditions common to veterans and family

members of veterans. This symposium will satisfy that

requirement. The FMFWV is proud and honored to support

veterans everywhere, as Friday, November 11, 2016, was

Veterans Day.

FMFWV Fact: Veterans who are considering suicide often

show signs of depression, anxiety, low self-esteem, and/or

hopelessness.

3:50 “Depression/Anxiety”

Kimberly Foley, PhD

Frostburg, MD

FMFWV Fact: Post-traumatic stress disorder (PTSD) is a

mental health condition that is triggered by a terrifying event

– either experiencing it or witnessing it. Symptoms may

include flashbacks, nightmares, and severe anxiety, as well

as uncontrollable thoughts about the event.

4:50 “PTSD/Suicide Prevention”

Cornelius Thomas, MD

Huntington, WV


6:00 Adjournment

PAUL W. AMBROSE, MD

SPORTS MEDICINE PROGRAM

MORNING SESSION

Sunday, November 13, 2016

7:00am Complimentary Blood Drawing/

Chemistry Profile

2nd




Floor


Moderator – Trey Leaven, MD

Sports Medicine Fellow Marshall University


Huntington, WV

FMFWV Fact: Exercise can significantly improve child

and adolescent mental health outcomes.

8:00 “Evidence Based Exercise Prescription for

Child and Adolescent Mental Health”

Jeremy Sibold, ATC, EdD

Burlington, VT

MORNING SESSION


FMFWV Fact: Psychosocial screening can have a

significant impact on athletic performance, injury prevention,

and rehabilitation.

8:50 “Evidence Based Psychosocial Screening

Recommendations for Athletes and Injury

Prevention”


Burlington, VT


Floor

FMFWV Fact: In athletics, a catastrophic event plan can

significantly improve patient outcomes.

10:00 “When Things Go Bad in Sports:

Responding to Catastrophic Events”

Brian Potter, MS, ATC, EMTB

Charleston, WV

FMFWV Fact: A thorough pre-participation exam is the

primary means of identifying athletes at risk of sports injury

and initiating preventative measures.

10:50 “Pre Participation Exams”

Kevin Walter, MD

Milwaukee, WI

12:05pm Sunday Brunch Buffet/Exhibit Visitation

Foyer Area & Grand Ballroom – 2nd

Floor

Thanks to our Sunday sponsors:

AFTERNOON SESSION


12:50 pm “Overview of Afternoon Topics”

Moderator – Trey Leaven, MD

Sports Medicine Fellow

Marshall University


Huntington, WV

FMFWV Fact: Elbow and shoulder injuries in young

athletes are on the rise. Damage or tear to the ulnar

collateral ligament (UCL) is the most common injury

suffered and is often caused by pitchers throwing too much.

1:00 “Preventing Arm Injuries in Baseball”

Leo Mazzone

Atlanta, GA

FMFWV Fact: Athletes rarely present with symptoms /

clinical findings suggestive of vascular disease, but vascular

etiologies should be considered when athletes complain of

symptoms for presumed musculoskeletal injuries.

1:50 “Common Vascular Compromise

Conditions of the Physically Active”

Rae Emrick, MS, ATC, CSCS

Buckhannon, WV

FMFWV Fact: Selective joint injections are being

performed with increasing frequency in the management of

acute and chronic disorders of the musculoskeletal system.

2:40 “Selective Joint Injection Techniques”

Chad Showen, MSPAS, PA-C, MS, ATC

Marietta, OH


4:30 Adjournment

4:35 Door Prize Drawing for CME Registrants

Mezzanine – 2nd

Floor

You must be present to win.

FACULTY

(in alphabetical order)

Josh Cusick-Lewis, MD, MPH

Department of Family Medicine

WVU-Charleston Division

Charleston, WV

Mehiar El-Hamdani, MD

St. Mary’s Medical Center

Huntington, WV

Rae Emrick, MS, ATC, CSCS

West Virginia Wesleyan University

Buckhannon, WV

Kimberly Foley, PhD

WVU Family Medicine

Morgantown, WV

Peter H.R. Green, MD

Celiac Disease Foundation

New York, NY

Zach Hansen, MD

Valley Health Systems

Huntington, WV

Ramakrishnan Iyer, MBBS, FNLA

The Charleston Heart Specialists

Charleston, WV

Michael Kilkenny, MD

Medical Director, Cabell-Huntington Health Department

Huntington, WV

Leo Mazzone

Atlanta, GA

David Myerberg, MD, JD

Myerberg Law PLLC

Morgantown, WV

Robert A. Otero

Drug Enforcement Agency - Charleston

Charleston, WV

Jennifer Pearson, PhD, MPH

Schroeder Institute for Tobacco Research and Policy Studies

Truth Initiative

Washington, D.C.

Cindy Pinson, MD

Travel MD

Huntington, WV

FACULTY (continued, in alphabetical order)

Brian Potter, MS, ATC, EMT-B

Tygart Valley Orthopedics & Sports Medicine

Elkins, WV

Rene Rodriguez-Sains, MD, FACS, PC

Marshall Eye Surgeons – Ophthalmology

Huntington, WV

Christine Rosenbloom, PhD, RDN

Hartwell, GA

Jeremiah Samples

West Virginia Department of Health and Human Resources

Charleston, WV

Frank Schwartz, MD, FACE

Ohio University

Athens, OH

Chad Showen, MSPAS, PA-C, MS, ATC

Memorial Health System - Marietta Memorial Hospital

Marietta, OH


University of Vermont

Department of Rehabilitation & Movement Science

Burlington, VT

Daniel Snavely, MD

Huntington Internal Medicine Group (HIMG)

Huntington, WV

Jeannie Sperry, PhD, ABPP

Mayo Clinic

Rochester, MN

Cornelius Thomas, MD

VA Medical Center

Huntington, WV

Alison Vargovich, PhD

West Virginia University

Morgantown, WV

Kevin Walter, MD

Children’s Hospital of Wisconsin

Milwaukee, WI

Heather Wood, CFNP

Cabell-Huntington Health Department

Huntington, WV

EDUCATIONAL CONTRIBUTORS We would like to acknowledge the following organizations for

educational grants and/or speaker support:

Cabell-Huntington Health Department

Celiac Disease Foundation

Charleston Area Medical Center

The Charleston Heart Specialists

Chris Rosenbloom Food and Nutrition Services, LLC

Community Care of West Virginia

Drug Enforcement Agency – Charleston

Supported by an educational grant from Gilead Sciences

Huntington Internal Medicine Group (HIMG)

Indivior Inc. has provided unrestricted funding to support this

program

Johns Hopkins Bloomberg School of Public Health

Lincoln Primary Care Center

Marshall Eye Surgeons – Ophthalmology

Mayo Clinic

Memorial Health System - Marietta Memorial Hospital

Myerberg Law PLLC

Ohio University

Schroeder Institute for Tobacco Research and Policy Studies

Truth Initiative

St. Mary’s Medical Center

This activity has been supported through an independent educational

grant from Teva Pharmaceuticals

Travel MD

Tygart Valley Orthopedics & Sports Medicine

Valley Health Systems

VA Medical Center

University of Vermont

Department of Rehabilitation & Movement Science

West Virginia Department of Health and Human Resources

West Virginia University Department of Family Medicine

West Virginia Wesleyan University

SPEAKER DISCLOSURES

Unless listed below, speakers have disclosed that they have

no financial interest, arrangement, or affiliation with any

commercial organization, and will not be discussing any

products which they had a role in developing. These

speakers have also disclosed that they will not discuss any

off-label use or unapproved or investigational use of any

product.

Dr. Frank L. Schwartz disclosed an affiliation with

Medtronic Minimed Corporation, who sponsors his clinical

research studies, as well as a consulting relationship with

sanofi-aventis.

SPORTS CELEBRITY SPEAKER

Leo Mazzone

Mr. Leo Mazzone, who was born in West Virginia, is a

former pitcher and pitching coach in Major League Baseball.

With the Atlanta Braves, Mazzone earned a reputation as

one of the best pitching coaches in baseball, having

developed and coached some of the best pitching rotations in

baseball history. His dominant pitching anchored the Braves’

run of 14 consecutive division titles, five National League

pennants, and the 1995 World Series championship.

Between 1991 and 1998, three of Mazzone’s pitchers won a

total of six Cy Young Awards: Tom Glavine in 1991 and

1998, Greg Maddux in 1993, 1994, and 1995, and John

Smoltz – 1996. Mazzone’s “trademark” is his rocking back

and forth while sitting in the dugout. On television

broadcasts of Braves games, the camera would often show

him rocking back and forth during the game. Mazzone’s

pitching philosophies state that pitchers should throw more

between starts (two sessions instead of one) and be able to

throw strikes on the low and outside corner of the strike

zone.

https://en.wikipedia.org/wiki/Pitcher

https://en.wikipedia.org/wiki/Pitching_coach

https://en.wikipedia.org/wiki/Major_League_Baseball

https://en.wikipedia.org/wiki/Cy_Young_Award

https://en.wikipedia.org/wiki/Dugout_(baseball)

https://en.wikipedia.org/wiki/Strike_(baseball)

CORPORATE CONTRIBUTORS

The Family Medicine Foundation of West Virginia would

like to acknowledge the following organizations for their

generous contributions as corporate contributors:

CAMC Health Education and Research

QUILT DRAWING You do not need to be present to win.

Please support the Family Medicine Foundation

of West Virginia by purchasing a chance to win a

beautiful, hand-made, Appalachian quilt!

Entry forms may be found online at

www.fmfwv.org. You may also enter to win at the

registration desk.

The drawing will be held on

Sunday, November 13, 2016, at 4:35 pm

Located in the mezzanine – 2nd

Floor.

DOOR PRIZES Door prize drawings are for CME/CE registrants only.

You must be present to win.

MORE THAN EVER BEFORE!

DRAWINGS ALL THREE DAYS!

HD flat screen TV, microwave oven

Winterplace ski passes, restaurant gift cards

Starbucks gifts, Blenko Glass, and over 50 other

great prizes!

We are pleased to announce that the Family

Medicine Foundation of West Virginia has teamed

up with tri-state area businesses in order to support

our annual conference and provide a more

satisfying experience for our attendees! We will be

giving away locally-donated door prizes on all three

days of the conference. The grand prize drawing

will be Sunday, November 13, 2016 at 4:35 pm in

the upper mezzanine – 2nd

Floor.

Registration Fees Before Oct. 1 After Oct. 1 CME Hours Available

** Thursday (3-hour/$90 drug diversion lecture) 3.00

Physician (MD/DO) (3 days) $ 490.00 $ 570.00 Friday 8.17

(2 days) 450.00 500.00 Saturday 8.17

(1 day) 240.00 260.00 Sunday 7.25

APRN, PA, PT, OT (3 days) 345.00 395.00 Thurs. Fri, Sat, Sun. 26.50

(2 days) 245.00 295.00

(1 day) 160.00 170.00

Pharmacist, RN, PTA (3 days) 290.00 335.00

(2 days) 240.00 270.00

(1 day) 135.00 165.00 Please make Checks Payable To:

Chiropractic Physician (Sunday Only) 185.00 210.00 Family Medicine Foundation of West Virginia

ATC, Coach (3 days) 275.00 300.00 650 Main Street, Barboursville, WV 25504

(2 days) 225.00 240.00 Phone: 304.733.6485 Fax: 304.733.6486

(1 day) 160.00 170.00

Resident, Medical Student, Student Trainer *Flat Fee 60.00* 60.00*

Sorry, no credit cards accepted.

Fees include registration, breakfast, lunch, breaks, and the Friday evening reception. Online Registration is available at www.fmfwv.org.

Thursday drug diversion lecture (includes dinner) Flat Fee 95.00 95.00

There are no penalties for cancellation.

A 100% refund will be given if notified by

November 13, 2016.

http://www.fmfwv.org/

PLEASE RETURN CME REGISTRATION FORM TO: Family Medicine Foundation of West Virginia, 650 Main Street, Barboursville, WV 25504

30th Annual José I. Ricard, MD Family Medicine & Sports Medicine Conference (November 10-13, 2016)

Name ________________________________________________________________________________ Days Attending Fri Sat Sun (Please Print)

Will you attend the Thursday, Nov. 10 controlled substances monitoring lecture? (new CME/CE requirement for WV licensure renewal) Yes

(this lecture is an additional $95.00)

Profession (MD, DO, DC, PA, RN, APRN, Pharmacist, PT, ATC, etc) _________________ If APRN or FNP, License # _____________________

Mailing Address _______________________________________________________ E-mail _____________________________________________ (We do not share email addresses.)

City, State, Zip _________________________________________________ Phone _________________________ Fax _______________________

Name of Spouse/Guest _______________________________________________ RSVP Friday Reception ___________ Limited to first 200 to RSVP (Please Print) (# Attending)

Would you like to receive your conference handouts in a notebook or on a flash drive? Notebook Flash drive

……………………………………………………………………………………………………………………………………………..………………………

OFFICE USE: Amount Paid _____________________ Check # _________________ Ck Date _________________ Owes ______________________

Family Medicine Foundation of West Virginia

650 Main Street

Barboursville, WV 25504

Phone: (304) 733-6485

Fax: (304) 733-6486

Return Service Requested

Register by October 1, 2016 to get the discounted fee!

26.50 Hours CME/CE Credit

Documents

The Family Medicine Foundation - 30th Annual... · November 10 - 13, 2016 CONFERENCE ACCREDITATION thThis live activity, the 30 Annual José I. Ricard, MD Family Medicine & Sports