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American Society of
Interventional Pain Physicians
PRSRT STD
U.S. POSTAGE
PAID
81 Lakeview Drive, Paducah, KY 42001
PADUCAH, KY
PERMIT #44
CADAVER WORKSHOP
AND ONLINE VIDEO LECTURES
(BASIC, INTERMEDIATE, AND ABIPP PREPARATION)
UP TO 14.75 AMA PRA CATEGORY 1 CREDITS™ FOR WORKSHOP AND
UP TO 7 AMA PRA CATEGORY 1 CREDITS™ FOR VIDEO LECTURES
OCTOBER 18-19, 2014 | ORLANDO, FLORIDA
HOST HOTEL:
ROSEN CENTRE HOTEL, 9840 INTERNATIONAL DR, ORLANDO, FL 32819. (800)204-7234. WWW.ROSENCENTRE.COM
CADAVER WORKSHOP:
CENTRAL FLORIDA, COLLEGE OF MEDICINE, 6850 LAKE NONA BLVD, ORLANDO, FL 32827. HTTP://MED.UCF.EDU/
SPECIALS:
• SPECIAL ROOM RATES THROUGH SEPTEMBER 16, 2014
• 50% OFF MEETING FEE TO FELLOWS & RESIDENTS
ASIPP® EDUCATIONAL SERVICES | EXCELLENCE IN EDUCATION OF INTERVENTIONAL PAIN PHYSICIANS
HOST HOTEL:
ROSEN CENTRE HOTEL
9840 INTERNATIONAL DRIVE
ORLANDO, FL 32819
(800) 204-7234
HTTP://WWW.ROSENCENTRE.COM
CADAVER WORKSHOP:
CENTRAL FLORIDA, COLLEGE OF MEDICINE
6850 LAKE NONA BLVD
ORLANDO, FL 32827
HTTP://MED.UCF.EDU/
SPECIALS:
• SPECIAL ROOM RATES THROUGH SEPTEMBER 16, 2014
• 50% OFF MEETING FEE TO FELLOWS & RESIDENTS
CADAVER WORKSHOP
AND
ONLINE
VIDEO
LECTURES
CADAVAR WORKSHOP- BASIC, INTERMEDIATE, AND ABIPP PREPARATION
OCTOBER 18-19, 2014 | ORLANDO, FLORIDA
UP TO 14.75 AMA PRA CATEGORY 1 CREDITS™ FOR WORKSHOP AND
UP TO 7 AMA PRA CATEGORY 1 CREDITS™ FOR VIDEO LECTURES
American Society of
Interventional Pain Physicians
The Voice of Interventional Pain Management since 1998
CADAVER WORKSHOP AND ONLINE VIDEO LECTURES | BASIC, INTERMEDIATE, AND ABIPP PREPARATION
OCTOBER 18-19, 2014 | ORLANDO, FLORIDA
DESCRIPTION, PURPOSE AND TARGET AUDIENCE
This 1½-day workshop is designed for interventional pain physicians, for a
review, skills improvement, or to assist in preparation for Comprehensive
Interventional Pain Management Examination qualifications. ASIPP
offers the most in-depth, comprehensive, and individualized programs
available in interventional pain management, featuring maximum
hands-on training with cadavers in a state-of-the-art facility and maximum
ability to interact with other participants. Participants will experience
a comprehensive and intense learning opportunity, focusing on
interventional pain management techniques.
• Each cadaver station is limited to a maximum of 7 participants.
• Participants can choose the level of participation: basic, intermediate, or
ABIPP Preparation
• C-arms and state-of-the-art equipment are utilized in this course.
Participants are requested to dress in casual attire or scrubs. Leaded
aprons and thyroid shields will be provided. However, participants are
advised to bring their own protective eyewear.
• Participants will be provided with 7 video lectures relevant to the course
material
The workshop is offered to improve the delivery of multiple aspects of
interventional pain management. The desired outcome is to integrate
multiple aspects of interventional pain management in treating your
patients so that patients have better outcomes and reduced side effects.
OUTCOME
Physicians should be able to integrate multiple aspects of interventional
pain management techniques in patient treatments so that patients have
better outcomes and reduced side effects.
ACCREDITATION AND CME CREDIT STATEMENTS
This live and online CME activity has been planned and implemented
in accordance with the Essential Areas and Policies of the Accreditation
Council for Continuing Medical Education thru the Joint Sponsorship of
the Institute for Medical Studies (IMS) and ASIPP. IMS is accredited by the
ACCME to provide continuing medical education for physicians.
The Institute for Medical Studies designates this educational activity for
a maximum of 21.75 AMA PRA Category 1 Credits™. Physicians should only
claim credit commensurate with the extent of their participation in the
activity.
AMERICANS WITH DISABILITIES ACT & SPECIAL SERVICES
Organizers fully comply with the legal requirements of the Americans with
Disabilities Act and the rules and regulations thereof. If any participant in
these educational activities is in need of accommodations, please contact
the organizers at (270) 554-9412 at least 10 days prior to each conference.
CADAVER WORKSHOP SITE
The cadaver facility will be at the University of Central Florida, College of Medicine,
6850 Lake Nona Blvd., Orlando, FL 32827. http://med.ucf.edu/
THERE IS NO COMMERCIAL SUPPORT FOR THIS COURSE. NO DUPLICATION OR DISTRIBUTION OF MATERIALS, OR RECORDING OF LECTURES ASSOCIATED. THERE IS NO COMMERCIAL SUPPORT FOR THIS COURSE.
CADAVER LAB COURSE LEVELS
BASIC
1. Caudal epidural injections
2. Lumbar interlaminar epidural
injections
3. Lumbar transforaminal epidural
injections
4. Sacroiliac joint interventions
5. Lmbar facet joint nerve blocks
6. Lumbar facet radiofrequency
neurotomy
INTERMEDIATE
1. Lumbar discography and adhesiolysis
2. Lumbar sympathetic blocks and hypogastric
plexus blocks
3. Lumbar facet joint nerve blocks and
radiofrequency neurotomy
4. Cervical and thoracic interlaminar epidurals
5. Thoracic facet interventions (medial branch
blocks, and radiofrequency neurotomy)
6. Cervical facet joint interventions
(medial branch blocks, and radiofrequency
neurotomy)
ACCOMMODATIONS
Rosen Centre Hotel
9840 International Drive
Orlando, FL 32819
(800) 204-7234
Rosen Centre raises the bar in guest service, convenience and value among
Orlando hotels with the numerous amenities at the 1,334-room, awardwinning convention property. Inform the agent that you are booking
for American Society of Interventional Pain Physicians.
We have secured a group room rate of $129. Reserve rooms early—
all unbooked rooms will be released after September 16, 2014.
AMERICAN SOCIETY OF INTERVENTIONAL PAIN PHYSICIANS
ABIPP PREPARATION
1. Caudal epidural, interlaminar epidural, transforaminal, and
percutaneous adhesiolysis
2. Lumbar facet joint interventions (facet joint nerve blocks, and
radiofrequency neurotomy) and sacroiliac joint injections
3. Thoracic facet joint interventions (medial branch blocks and
radiofrequency neurotomy), intercostal nerve blocks, and thoracic
interlaminar epidural injections
4. Cervical facet joint interventions (medial branch blocks and
radiofrequency neurotomy) and cervical interlaminar epidural
injections
5. Spinal cord stimulation lead placement and lumbar discography
6. Sympathetic blockade (stellate ganglion, lumbar sympathetic
blocks and celiac plexus blocks)
CADAVER WORKSHOP AND ONLINE VIDEO LECTURES | BASIC, INTERMEDIATE, AND ABIPP PREPARATION
OCTOBER 18-19, 2014 | ORLANDO, FLORIDA
COMPREHENSIVE REVIEW COURSE
NOTE: THE ONLINE REVIEW COURSE VIDEOS SHOULD BE VIEWED PRIOR TO ATTENDING THE HANDS-ON CADAVER WORKHANDS-ON CADAVER WORKSHOP (BASIC, INTERMEDIATE, AND ABIPP PREPARATION)
SATURDAY OCTOBER 18, 2014
6:45am SHUTTLES DEPART FROM HOTEL TO THE CADAVER FACILITY
7:00am–8:00am REGISTRATION AND BREAKFAST
8:00am–8:30am INTRODUCTION
8:30am–12:00pm
HANDS-ON CADAVER WORKSHOP
12:00pm–1:00pm LUNCH
1:00pm–5:30pm
HANDS-ON CADAVER WORKSHOP
5:30pm SHUTTLES DEPART FROM CADAVER FACILITY TO THE HOTEL
HANDS-ON CADAVER WORKSHOP (BASIC, INTERMEDIATE, AND ABIPP PREPARATION)
SUNDAY OCTOBER 19, 2014
6:45am SHUTTLES DEPART FROM HOTEL TO THE CADAVER FACILITY
7:00am–8:00am REGISTRATION AND BREAKFAST
8:00am–8:30am INTRODUCTION
8:00am–12:00pm
HANDS-ON CADAVER WORKSHOP
12:00pm SHUTTLES DEPART FROM CADAVER FACILITY TO AIRPORT AND HOTEL
AMERICAN SOCIETY OF INTERVENTIONAL PAIN PHYSICIANS
CADAVER WORKSHOP AND ONLINE VIDEO LECTURES | BASIC, INTERMEDIATE, AND ABIPP PREPARATION
OCTOBER 18-19, 2014 | ORLANDO, FLORIDA
REGISTRATION FORM
REGISTRATION INFORMATION
PLEASE PRINT EXACTLY AS YOU WISH YOUR NAME TO APPEAR:
IMPORTANT. Please answer all the questions:
PRIMARY SPECIALTY CERTIFICATION:
m Anesthesiology m Physiatry
m Neurosurgery m Other: _______________________________
PAIN MEDICINE SUBSPECIALTY CERTIFICATION:
m ABMS Pain Medicine (Anesthesiology, PMR, Neurology, Psychiatry,
_____________________________________________________________________________________________________
NAME
(FIRST)
(MIDDLE INITIAL)
(LAST)
(DEGREE)
_____________________________________________________________________________________________________
ORGANIZATION
Emergency Medicine)
m American Board of Pain Medicine
m American Board of Interventional Pain Physicians
m Fellow of Interventional Pain Practice (FIPP)
_____________________________________________________________________________________________________
ADDRESS
SPECIALTY DESIGNATION:
m 09 - Interventional Pain Management
m 72 - Pain Management
m Other: ______________________________________
_____________________________________________________________________________________________________
CITYSTATEZIP
PERCENTAGE OF INTERVENTIONAL PAIN
MANAGEMENT PRACTICE:
m 0% m 1-25% m 26-50% m 51-75% m > 75%
_____________________________________________________________________________________________________
PHONEFAX
YEARS IN INTERVENTIONAL PAIN
MANAGEMENT PRACTICE:
m 0
m 1-5
m 6-10
m > 10
MEDICAL DEGREE:
m MD m DO
m Additional: _______________________________
COURSE LEVEL: CADAVER
m Basic m Intermediate m ABIPP Preparation
TOTAL NUMBER OF PROCEDURES PERFORMED
DURING PAST YEAR:
LOCATION
_____________________________________________________________________________________________________
E-MAIL
COMPREHENSIVE REVIEW COURSE AND CADAVER WORKSHOP
Registration Fees: m $2,500 Member
Fellows:
m 50% Discount***
m $2,800 Non-Member
***If registering as a 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 50% discount
until ASIPP receives this letter. Fax the letter to 270-554-5394 or e-mail to [email protected]
ASC HOPDOffice
Caudal Epidural _____ _____ _____
Stellate Ganglion Blocks _____ _____ _____
Thoracic Sympathetic Blocks
_____ _____ _____
Lumbar Sympathetic Blocks
_____ _____ _____
Lumbar Facet Joint Blocks
_____ _____ _____
Thoracic Radiofrequency _____ _____ _____
Thoracic Interlaminar
_____ _____ _____
Cervical Interlaminar _____ _____ _____
Epidurals _____ _____ _____
Cervical Facet Joint Blocks _____ _____ _____
Cervical Radiofrequency
_____ _____ _____
Thoracic Joint Blocks
_____ _____ _____
Thoracic Radiofrequency
_____ _____ _____
Lumbar Radiofrequency
_____ _____ _____
Lumbar Transforaminal
Epidural _____ _____ _____
Hypogastric Plexus _____ _____ _____
Sacroiliac Joint Injections
_____ _____ _____
Pyriformis Block
_____ _____ _____
Percutaneous Adhesiolysis
_____ _____ _____
_____________________________________________________________________________________________________
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 September 16, 2014. An administrative
fee of $200 will be assessed. Cancellations after September 16, 2014 but prior to October 6, 2014, will forfeit 50% of
their registration fee. No cancellations accepted after October 6, 2014 will be accepted. Refunds will be sent after the
conclusion of the meeting.