registration form - driscoll children's hospitalpresents pediatric conference july 8-9, 2016...

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presents PEDIATRIC CONFERENCE July 8-9, 2016 Omni Bayfront Hotel Corpus Christi, Texas 3533 S. Alameda Street Corpus Christi, Texas 78411 Non-Profit Organization U.S. Postage PAID Corpus Christi, TX Permit No. 712 Pediatric Conference Participant’s Name: ������������������������������������������������������������� Professional Suffix: ������������������������������������������������������������� Mailing Address: ��������������������������������������������������������������� City, State, ZIP: ���������������������������������������������������������������� Office Phone: ����������������������������������������������������������������� Fax Number: ������������������������������������������������������������������ Email address: ����������������������������������������������������������������� Emergency Contact Name: ������������������������������������������������������ Emergency Contact Phone: ������������������������������������������������������ Allergy Restrictions: ������������������������������������������������������������ Conference Registration Fee: q $350 q $325 (DCH Alumni Physicians) q $30 (Syllabus) Cancellations: A refund, minus a $75 processing fee, will be given if cancellation is received by June 24, 2016. No refunds will be issued after June 24, 2016. Mail check to: (payable to: Driscoll Children’s Hospital) Driscoll Children’s Hospital Maria Campbell Medical Staff Services 3533 South Alameda Street Corpus Christi, Texas 78411 Charge my credit card: q VISA q MasterCard q AMEX Amount: �������������� Card No: Exp. Date: ��������������������������������� Cardholder Name: �������������������������������������������������������� Signature: ��������������������������������������������������������������� Registration Form 23rd Annual Register online, visit at www.regonline.com/2016pedconf To download brochure, www.driscollchildrens.org Due to changing climate conditions in the room, please bring a jacket. Office use only: PEDIATRIC CONFERENCE q Please check here if you require any special assistance to fully participate in this conference. A staff member will contact your prior to the meeting to discuss accommodations. 12 AMA PRA Category 1 TM 1 Ethics Credit

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Page 1: Registration Form - Driscoll Children's Hospitalpresents PEDIATRIC CONFERENCE July 8-9, 2016 Omni Bayfront Hotel Corpus Christi, Texas 3533 S. Alameda Street Corpus Christi, Texas

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Participant’s Name: �������������������������������������������������������������

Professional Suffix: �������������������������������������������������������������

Mailing Address: ���������������������������������������������������������������

City, State, ZIP: ����������������������������������������������������������������

Office Phone: �����������������������������������������������������������������

Fax Number: ������������������������������������������������������������������

Email address: �����������������������������������������������������������������

Emergency Contact Name: ������������������������������������������������������

Emergency Contact Phone: ������������������������������������������������������

Allergy Restrictions: ������������������������������������������������������������

Conference Registration Fee:q $350

q $325 (DCH Alumni Physicians)

q $30 (Syllabus)

Cancellations: A refund, minus a $75 processing fee, will be

given if cancellation is received by June 24, 2016.

No refunds will be issued after June 24, 2016.

Mail check to: (payable to: Driscoll Children’s Hospital)Driscoll Children’s HospitalMaria CampbellMedical Staff Services3533 South Alameda StreetCorpus Christi, Texas 78411

Charge my credit card: q VISA q MasterCard q AMEX Amount: ��������������

Card No:

Exp. Date: ���������������������������������

Cardholder Name: ��������������������������������������������������������

Signature: ���������������������������������������������������������������

Registration Form

23rd Annual

Register online, visit at www.regonline.com/2016pedconf To download brochure, www.driscollchildrens.org

Due to changing climate conditions in the

room, please bring a jacket.

Office use only:

PEDIATRIC CONFERENCE

q Please check here if you require any special assistance to fully participate in this conference. A staff member will contact your prior to the meeting to discuss accommodations.

12 AMA PRACategory 1TM

1 Ethics Credit

Page 2: Registration Form - Driscoll Children's Hospitalpresents PEDIATRIC CONFERENCE July 8-9, 2016 Omni Bayfront Hotel Corpus Christi, Texas 3533 S. Alameda Street Corpus Christi, Texas

PEDIATRIC CONFERENCE 2016PROGRAM DIRECTORSThomas Morris, MDChairman, CME Committee Driscoll Health System Corpus Christi, Texas

AUDIENCEThis program is designed to provide pediatricians and family practitioners who care for infants, children, and adolescents interested in enhancing their understanding and developing solutions for clinical issues encountered in daily practice.

OBJECTIVESThe program is designed to increase knowledge and provide a comprehensive review of current clinical challenges in selected pediatric subspecialty areas.

EDUCATIONAL METHODSConference formats will include didactic lectures, interactive sessions, case studies, and question and answer sessions. Audience participation is encouraged throughout the conference.

COURSE SYLLABUSAn extensive program syllabus on USB contains pertinent information on each conference topic. Upon request, a hard copy syllabus will be provided for a fee of $30. Please order when registering.

DISCLOSUREAll faculties and planning committee members participating in a Driscoll Health System sponsored CME activity will disclose to the audience any significant financial interest or other relationship with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in an educational presentation, and with the commercial supporter of this activity. Disclosure information is reviewed in advance to manage and resolve any conflict of interest that may affect the balance and scientific integrity of an educational presentation. Approval as a provider refers to recognition of educational activities only. Display or discussion of commercial products and services does not imply endorsement of the product or service by Driscoll Health System.

CME ACCREDITATION STATEMENTDriscoll Health System is accredited by the Texas Medical Association to provide continuing medical education for physicians. Driscoll Health System designates this live educational activity for a maximum of [twelve (12)] hours in AMA PRA Category I Credit ™. Physicians should only claim credit commensurate with the extent of their participation in the activity. This course has been designated by Driscoll Health System for [one (1)] hour of education in medical ethics and/or professional responsibility.

AgendaFriday, July 8, 201612:30 p.m. ..... Registration

1 p.m. .............. Marshall L. Land, Jr., MD Maintenance of Certification

2 p.m. .............. Fredrick McCurdy, MD STAR Kids

3 p.m. .............. Afternoon Break

3:15 p.m. ........ Melissa Mizesko, MD Lupus Disease

4:15 p.m. ........ Cris Johnson, MD Late Effects of Cancer and Its Treatments

Saturday, July 9, 20167:30 a.m. ........ Registration / Continental Breakfast

8 a.m. .............. Valentine Nduku, MD Management of Neuro Trauma Patients

9 a.m. .............. Shane Miller, MD Common Injuries of the Female Athlete

10 a.m. ........... Mid-Morning Break

10:15 a.m. ...... William Reed, MD Substance Drugs

11:15 a.m. ..... Michael Speer, MD Economic Reality of Pre Term Birth

12:15 p.m. ..... Lunch Provided

1:15 p.m. ........ Linda Parsi, MD (ETHICS) Revenue Enhancements

2:15 p.m. ........ Susan Wynne, MD Diagnosis and Treatment of Mood and Anxiety Disorders in Children and Adolescents

3:15 p.m. ........ Afternoon Break

3:30 p.m. ........ Robert Stratton, MD Uncommon Presentation of Genetic Disorders

4:30 p.m. ........ Javier Monagas, MD Vomiting! A Forceful or Effortless Job

Marshall L. Land, Jr., MD R.J. McKay, Jr., MD Green & Gold Professor of PediatricsUniversity of Vermont College of MedicineConsultant, American Board of PediatricsBurlington, Vermont

M. Cris Johnson, MDMedical Director, Pediatric Hematology/ OncologyCancer and Blood Disorder CenterDriscoll Children’s HospitalCorpus Christi, Texas

Fredrick McCurdy MDSTAR Kids Medical DirectorDriscoll Health Plan Corpus Christi, Texas

Shane Miller, MD, FAAPTexas Scottish Rite Hospital Sports Medicine CenterAssistant Professor, Orthopaedics and PediatricsUT Southwestern Medical CenterPlano, Texas

Melissa Mizesko, MDPediatric RheumatologyDriscoll Children’s HospitalCorpus Christi, Texas

Valentine Nduku, MDPediatric Neurosurgery Driscoll Children’s HospitalCorpus Christi, Texas

Linda Parsi, MD, MBA, CPEDC, FAAPPediatricianParsi PediatricsSan Antonio, Texas

GUEST FACULTY

SPEAKERS

ACCOMMODATIONS

ALUMNI FACULTYJavier Monagas, MD (2008) Assistant Professor of Clinical PediatricsPediatric Gastroenterology Hepatology / NutritionBaylor College of MedicineChildren’s Hospital of San Antonio

William J. (Jerry) Reed, MD, FAAPProfessor of Clinical PediatricsTexas A&M University College of MedicineNorth Texas College of Osteopathic MedicineDevelopmental Behavioral PediatricsDriscoll Children’s Hospital Corpus Christi, Texas

Michael E. Speer, MDProfessor of Pediatrics & Ethics Baylor College of MedicinePresident of the Medical Staff Texas Children’s HospitalHouston, Texas

Robert Stratton, MDPediatric Genetics Driscoll Children’s HospitalCorpus Christi, Texas

Susan Wynne, MDClinical Associate Professor of Psychiatry University of Texas Health Science Center at San AntonioVice President, Bexar County Psychiatric SocietySan Antonio, Texas

**We reserve the right to replace speakers and /or topics to provide optimal educational opportunity for the attendees.

The conference will be held at Omni Bayfront Hotel at 909 North Shoreline Blvd., Corpus Christi, Texas 78401, (361) 887-1600. Please mention the Driscoll Children’s Pediatric Conference to receive the conference rate of $135 for single or double occupancy. Reservation must be made on or before cut-off date: June 13, 2016. Check in at 3 p.m. Check out at 12 p.m. Parking: $18 valet parking / $10 self-parking (self-parking waived for registrants).

HOW TO REACH US Maria CampbellMedical Staff ServicesPhone: (361) 694-4117Fax: (361) 808-21113533 South Alameda StreetCorpus Christi, Texas 78411Email: [email protected] our website: www.driscollchildrens.org