Goal Accreditation/Credit Designation

Self-Assessment Module
4:30 pm Adjourn
THIS IS NOT A SELF-MAILER - Address to:
3:00
Highest Degree
Post Conference Sessions for
attendees wishing to obtain SAM credit:
MI
3:00Adjourn
First
Q & A Panel
Last Name
2:30
How To Start A Successful Breast I-125 Radioactive Seed
Localization Program In Your Institution
Coding and Billing
Christie M. Canady
Specialty
2:00
Department (include box no.)
Pitfalls, Potential Issues and How To Take Precautions
Wei Yang, MD
oNo
1:30
oYes
VideoCast
Physician
1:00
Please visit www.mdanderson.org/conferences to register or
mail form to: CME/Conference Management- Unit 1781, The University
of Texas MD Anderson Cancer Center, PO Box 301407, Houston, TX
77230-1407. You may also fax the form to 713-794-1724.
Institution
Lunch / Q&A Panel Discussion
Morning Speakers
Registration
State/Foreign Country/Zip or Mail Code
12:15 pm
A 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.
City
Radiation Safety and Regulation
Sandra M. Jimenez
Street
11:45
Evaluation
Upon request, 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.
Department of CME/Conference Management-Unit 1781
The University of Texas MD Anderson Cancer Center
PO Box 301407, Houston, TX 77230-1407
or fax to 713-794-1724
Make check or money order payable to:
The University of Texas MD Anderson Cancer Center
Management of Seed in the Specimen:
Work-Flow in Pathology
Michael Gilcrease, MD, PhD
Lecture/Didactic, Audience Response System, Panel Discussion,
Question/Answer Sessions
Fax (with area code)
11:15
Educational Methods
Cell Phone (with area code)
RSL-Guided Surgery: Nuts and Bolts
Shon Black, MD
Registration Fees (No SAM) Credit
10:45
This conference will be beneficial to Radiologists, Surgeons, Pathologists,
Radiation Safety Officers, and Hospital Administrators
1 Postmarked on or before April 10, 2015.............$395
1 Postmarked after April 10, 2015..........................$495
Seed Workflow in Radiology:
From Seed Ordering to Placement
Mark J. Dryden, MD
10:15
Phone (with area code)
Charge the following:
oVISA
oMasterCard
oAmerican Express
Credit Card Holder Billing Address & ZIP Code
Certificates awarding AMA PRA Category 1 Credits TM, SAM credits and
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.
SAM Credit Registration Fees
10:00Break
Target Audience
CME Certificates and Attendance Verification Certificates
Expiration Date
Authorized Usership: Definition and Responsibilities
within Breast RSL Framework
Eric Rohren, MD, PhD
1 Postmarked on or before April 10, 2015.............$525
1 Postmarked after April 10, 2015..........................$625
9:30
Submitted to the ABR for approval in meeting the criteria for
self-assessment toward the purpose of fulfilling requirements in
the ABR Maintenance of Certification program.
Fund Type
Seed Storage, Calibration and Tracking
Bill Erwin
Fund
9:00
Fund Group*
SAM Credits
Trainee Registration Fees*
Initiating and Completing DSHS Application
Sandra Jimenez
MD Anderson Employee ID No. (REQUIRED)
8:30
1 Postmarked on or before April 10, 2015.............$295
1 Postmarked after April 10, 2015..........................$375
IDT Approver E-mail
This conference has been certified for the level 2 classification in
accordance with the AMA guidelines for Continuing Medical Education
on New Procedures and Skills.
*All trainees must submit a letter of validation from
their department chair.
After participating in the activity, the participant should be able to:
• Initiate and complete a DSHS application
(knowledge, competence, performance);
• Apply a pathway of seed ordering, storage, assay and tracking
(knowledge, competence, performance);
•Implement principles of seed localization procedure (RSL)
(knowledge, competence, performance);
•Understand principles of seed-guided surgery (knowledge);
•Incorporate necessary steps to ensure safe seed handing in pathology
(knowledge, competence, performance and patient outcomes).
Daytime Phone (with area code)
How to Start a Breast I-125 RSL Program
In Your Institution: An Overview
Basak E. Dogan, MD
E-mail Address (please print)
8:00
Emergency Contact
Welcome and Announcements
Wei Yang, MD
Credit Card Holder Name (First/Last)
7:50
Credit Card Number
Registration and Continental Breakfast
Department
Educational Objectives
The University of Texas MD Anderson Cancer Center designates this live
activity for a maximum of 8.5 AMA PRA Category 1 Credits TM. Physicians
should claim only the credit commensurate with the extent of their
participation in the activity.
7:30 am
Business Unit
The University of Texas MD Anderson Cancer Center is accredited by
the Accreditation Council for Continuing Medical Education (ACCME) to
provide continuing medical education for physicians.
How To Start A Successful Breast I-125 Radioactive
Seed Localization Program In Your Institution - May 9, 2015
MD Anderson Interdepartmental Transfer (IDT) No.: *Fund Group 90 will not be accepted
Participants should come away from this course with a clear
understanding of the regulations, application process, seed protocoling
and procedure planning by the radiologist, seed insertion, surgical
techniques and principles, pathology processing and seed storage/
dispensing, associated with performing RSL procedure.
Agenda
Authorized Signature REQUIRED for credit card or IDT
Accreditation/Credit Designation
IDT Approver Name (First/Last) please print
Goal