Interprofessional Core Curriculum
an interprofessional workshop
Childhood Cancer: Interprofessional Team Management of the Child with Cancer
Thursday, October 8, 2009, 5:00 – 7:00 PM
IWK Health Centre – Classroom A, 5850/5980 University Avenue, Halifax, NS
Please arrive 15 minutes prior to the start time of the workshop.
Facilitators:
Bruce Crooks, Pediatric Hematologist/Oncologist, IWK Kara Henman, Oncology Practice Consultant, CCNS Session will also be available via videoconference, with a limited number of participants, at the following sites: • • • Bridgewater (South Shore Regional Hospital, Lecture Room 1, 2 & 3) Lunenburg (Fishermen’s Memorial Hospital, Old Nursery) Yarmouth (Yarmouth Regional Hospital, 5C)
This program has been accredited by Dalhousie University, Continuing Medical Education and the Division of Continuing Pharmacy Education. For credentialing details, please see the registration form. Space is limited – please register early. To register: Fax registration form on the back of this page to Cancer Care Nova Scotia at 902-473-6412, Attention: Allison MacDonald. Registration form is also available at: www.cancercare.ns.ca
Childhood Cancer: Interprofessional Team Management of the Child with Cancer
IWK Health Centre – Classroom A, 5850/5980 University Avenue, Halifax NS
Thursday, October 8, 2009 5:00 – 7:00 PM REGISTRATION FORM
Please PRINT clearly and complete form in full. Thank you. Name: ________________________________________ Email: _____________________________ Work Address: Hospital/Facility Name ________________________________________________ Department___________________ Unit __________ Floor _____ Street Number ______________ Street Name ________________________City ___________________ Postal Code ____________ Phone: (W) (____) _______________ (H) (_____) _____________ Fax: (____) _______________
Please check one: Family Physician Physician Specialist – please specify _____________________________________ Nurse – please specify ________________________________________________ LPN – please specify _________________________________________________ Social Worker Spiritual Care/Chaplain Pharmacist Dietitian Other – please specify ________________________________________________ I work in a: Community setting Hospital setting Long-Term care setting
I intend to take part via videoconference at the following site (please check one):
Bridgewater (SSRH) Lunenburg (FMH) Yarmouth (YRH)
As an accredited provider, Dalhousie University, CME designates this continuing medical education activity for 3.5 credit hours for MAINPRO M-1 of the College of Family Physicians of Canada and reciprocally for the American Academy of Family Physicians. This event is an accredited group learning Section 1 activity as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada and reciprocally for AMA Category 1 of the Physician’s Recognition Award. This program is accredited for 3.5 CEU’s by the Division of Continuing Pharmacy Education, College of Pharmacy, file number CED-2009-011. The College of Registered Nurses of Nova Scotia has adopted a continuing competence program, “Building Your Profile,” to assist registered nurses with a mechanism to maintain their ongoing competence. Registered nurses, in identifying their learning needs around the care of oncology patients and their families, will benefit from this educational program that engages them in reflective practice and the integration of learning into their practice. CCNS collects and uses your above information for administrative purposes related to this session. For physicians only: this information is also provided to Dalhousie CME for CME credit. CCNS retains this information for follow-up with participants (this may include contacting you for research and evaluation purposes) and to keep a history of an individual’s participation in CCNS educational programs. CCNS does not use or share any individuals’ information for other purposes without obtaining the individual’s consent. CCNS Privacy Statement is available on our website.
Space is limited – please register early. To register: Please fax this form to 902-473-6412, Attention: Allison MacDonald.