Advanced Practice Sonographer (APS) Membership Application by dnl19611

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									        APS Membership Application & Guidelines




                Advanced Practice Sonographer
                             (APS)
                         Membership
                   Application & Guidelines




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        APS Membership Application & Guidelines


Introduction                                                   Table of Contents                                                Page
The Advanced Practice Sonographer (APS) membership             Eligibility Information.................................................... 3
category was designed by the SDMS to serve as a model          Application Process ..................................................... 3
for recognition of clinical excellence through appropriate     APS Audit System ....................................................... 4
standards of initial and continuing education, specialty       APS Appeal Process ................................................... 4
certification, clinical experience, and professional           Frequently Asked Questions (FAQs) ........................4-5
publication. These guidelines were designed by SDMS to
assist you in preparing application for APS membership.        Application
The purpose of the application process is to ensure that the   APS Membership Application (page 1) ........................ 6
applicant has met the standards established by the SDMS        APS Membership Application (page 2) ........................ 7
for APS membership.                                            Processing Fee............................................................ 8
                                                               Membership Dues (Initial and Renewal)...................... 8
The SDMS appreciates your interest in becoming an
APS member. If you have any questions or need further          Membership Renewal
assistance after reviewing the Guidelines, please contact      Annual Renewal Process ............................................ 9
the SDMS Membership Marketing & Service Department.            Adding APS Specialties ............................................... 9
Common questions and answers can be found in the APS
Frequently Asked Questions (FAQs), beginning on page 4.        Appendix A - Forms
                                                               APS Documentation Letter Template (APS-DL1) ...... 11
This publication is available on the SDMS website at           APS Renewal Documentation Letter
http://www.sdms.org/membership/, and may be downloaded             Template (APS-DL2) ......................................... 12
for your use.                                                  APS CME Log Template (APS-CME) ........................ 13
                                                               Employment Documentation (APS-ED1)................... 14



Society of Diagnostic Medical Sonography
Membership Marketing & Services Department
2745 N Dallas Pkwy Ste 350
Plano, TX 75093-8730
Phone: 214-473-8057
Fax:   214-473-8563
Email: membership@sdms.org




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        APS Membership Application & Guidelines


Eligibility Information                                         Step 3
Determine if your are eligible for this membership              Request and submit an official transcript from the
category. If you answer “yes” to each of the following          university/college at which your bachelor’s degree was
questions, you are eligible to apply for SDMS APS               bestowed. Contact the Registrar’s Office and request an
Membership.                                                     “official” transcript. This transcript must be clearly marked
                                                                as an “official transcript” and must be submitted with all
1. Have you been registered with the ARDMS or CCI for           requested documentation for APS membership.
   at least five (5) years in each specialty area in which
   you want to obtain APS membership?
                                                                Step 4
2. Do you work a minimum of 24 hours per week                   Submit copies of CME certificates and a completed APS
   clinically or in the supervision of clinical work and        CME Log (form APS-CME) for verification.
   800 scans in each specialty area in which you want
   to obtain APS membership?                                    Prior to submitting CME certificates to the SDMS, please
                                                                document 15 hours of CME credit in each specialty area
3. Do you have a bachelor’s degree in Diagnostic                in which you want to obtain APS membership on the
   Medical Sonography, Cardiovascular Technology,               APS CME Log (form APS-CME). If you have courses that
   or Echocardiography from an accredited university/           contain credits from multiple areas (ie. annual meetings)
   college?                                                     or courses with vague titles (ie. “Grand Rounds”), list only
4. Have you acquired 15 hours of CME credit in the              the amount of CMEs from each course which you are
   past three (3) years in each specialty area in which         using to complete this requirement.
   you want to obtain APS membership?                           NOTE: CMEs granted in the Other [OT] category are not
5. Have you been published or accepted for publication          accepted for any specialty area. All CME credits must
   in a peer-reviewed journal as author or co-author?           have been obtained within the immediate past three
                                                                (3) years AND must be ARDMS or CCI acceptable as
If you answered “yes” to all of the preceding questions,
                                                                appropriate. The APS CME Log MUST be accompanied
please proceed to the next section.
                                                                by copies of your CME certificates. (You may submit
                                                                multiple copies of the APS CME Log if you need
                                                                additional space when listing CME courses.)
Application Process
Step 1                                                          Step 5
Complete the entire APS Membership Application
included in this publication, beginning on page 6. Please       Submit a copy of your published (or accepted) peer-
provide all requested information and documentation.            reviewed journal article. This article must be ultrasound
Incomplete or illegible applications will not be processed      related. List the journal name, article title, publication
and will be returned to the applicant for completion.           or acceptance date, and citation (page number and
                                                                publication volume) on the APS Membership Application.
                                                                If the article has been accepted, but not yet published,
Step 2                                                          please provide a copy of the journal editor’s publication
Obtain a notarized letter (form APS-DL1) from your              acceptance letter with a copy of the article.
employer documenting your job title, years of clinical
employment, and clinical work experience*. An “APS
Documentation Letter “ template is included in this             Step 6
publication and must be used when providing this                Submit your completed application and all required
information. The letter must be printed on institutional        documentation to the SDMS Membership Marketing &
letterhead and be notarized.                                    Services Department. Pay only application fees at this
                                                                time. If paying by check or money order, please make
Previous employment may not be verified by your                 payable to SDMS. Do not submit payment for dues at
current employer. Letters submitted not using the               this time.
“APS Documentation Letter” template will be returned
to the applicant along with all other submitted APS
documentation.

*Clinical work experience is defined as performing sonography
or direct supervision of diagnostic medical sonographers,
students, or others performing sonographic examinations.




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        APS Membership Application & Guidelines


APS Audit System                                                Question: What are the bottom-line rules for meeting
                                                                   the APS publication requirement?
This system is designed to monitor compliance with APS
standards set by the SDMS Board of Directors. An annual         Answer: The article must be an ultrasound related
random audit of APS member information will consist                research article, case study, or case report
of verification of APS specialty-specific clinical work            published n a peer-reviewed journal (i.e., JDMS).
experience and/or continuing education.                            Abstracts, books, posters, oral presentations, book
                                                                   chapters and the JDMS Diagnostic Challenge do
Appeal Process                                                     NOT meet the requirement. If you are unsure if
                                                                   your article will comply with APS requirements,
If an APS member is determined to be out of compliance             please contact the SDMS Membership Marketing
with APS membership requirements, whether that                     & Services Department at 800-229-9506, or by
noncompliance relates to the clinical work experience or           email at membership@sdms.org.
the continuing education component, the member will be
sent written notification. The notification will include the
basis for the determination and information regarding the       Question: I’m not the primary author on my published
appeal process and documentation needed to support an              article, do I meet the publication requirement?
appeal and reevaluation.
                                                                Answer: Yes, you may be listed in any place as a
If the member disagrees with the audit findings, the               co-author.
member may submit a letter of appeal to the SDMS
Membership Marketing & Services Department. The letter
should state the reasons for the appeal and include any         Question: Is there a registry test for the APS?
documentation to support the appeal. If the member does         Answer: APS is a SDMS membership category only.
not appeal within 30 days of notification, the audit findings      There is no registry test for APS.
will be considered final.
Upon receipt of the appeal and any supporting
documentation, the SDMS Executive Director will                 Question: Is the APS membership category designed
reevaluate the member’s APS file. The Executive Director           for multi-specialty recognition?
will notify the member within 60 days of receipt of the         Answer: The APS membership category was
appeal of the final determination.                                 primarily designed to recognize clinical expertise
                                                                   in a given area of sonographic clinical work. While
                                                                   it is theoretically possible to qualify for more
                                                                   than one specialty area APS recognition, the
APS FAQs                                                           requirements of 24 hours per week and 800 scans
                                                                   per year will be applied to each specialty area.
Question: Is “APS” a certification or professional
   designation and can it be used as a part of my
   signature?                                                   Question: Who can verify my clinical work experience
Answer: No, APS is a SDMS membership category                      on the APS Documentation Letter?
   only and as such shall not be used in conjunction            Answer: This information should be verified by
   with your signature.                                            your direct supervisor, supervising physician or
                                                                   personnel/human resources director.
Question: Does SDMS require that all APS
   membership requirements are met before the                   Question: Can I have my current employer verify
   application will be accepted?                                   employment information from another institution or
Answer: Yes.                                                       past employer?
                                                                Answer: No, your current employer may verify only
                                                                   the experience you have at your current place of
                                                                   employment. Past employment or employment at
                                                                   another institution must be verified by personnel at
                                                                   those institutions.




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        APS Membership Application & Guidelines



APS FAQs (continued)
Question: What do I do if a past employer has gone
   out of business and I need to document my clinical
   experience at that facility?
Answer: Submit a properly executed Employment
   Documentation Form (APS - ED1). That form can
   be found on page 14 of this publication.


Question: What steps will I have to take to renew my
   APS membership?
Answer: Please see the “Annual Renewal Process”
   section on page 9.


Question: What happens if I cannot meet the APS
   renewal requirements?
Answer: Your membership category will be changed to
   Active (ACT).


Question: Why are APS dues higher than the other
   individual SDMS membership categories?
Answer: The membership fee schedule is reviewed
   annually by the SDMS Board of Directors and the
   APS dues have been set to reflect the additional
   processing and verification time needed to insure
   the APS standards. This process requires individual
   handling and the process cannot be automated.


Question: What is the normal turnaround time for
   processing an APS membership application?
Answer: Normal processing time is 3-4 weeks, but this
   may vary in peak membership periods.


Question: What do I do if I have CMEs listed in the
   ‘Other’ category that actually belong to a specific
   specialty? ie. AB, AE...
Answer: All CMEs used to meet APS requirements
   must be specialty specific. You should contact the
   CME provider to petition category changes.




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           APS Membership Application & Guidelines


                                    Advanced Practice Sonographer (APS)
                                          Membership Application
        Please Print or Type
        Name: Mr./Ms./Dr. _________________________ __________________ ___ Credentials:_________________
                                            Last                                   First             MI

        Address 1:__________________________________________________________________________________

        Address 2:__________________________________________________________________________________

        City: _______________________________State/Province: _____________ Zip+4/Postal Code: ______________

        Country: ____________________________ Daytime Phone: (_____)_____________________ Ext: __________

        Email Address: ______________________________________________________________________________


        Current SDMS membership number:                                                    Female         Male


                   Please provide this information for verification and CME tracking purposes:

                  Birth Date:           /          /           Social Security Number:         XXX - XX -

        Please check the specialty area(s) for which you are applying for APS membership:

                    Abdomen             Cardiac (Adult)              Ophthalmology                    Vascular
                    Ob/Gyn              Cardiac (Pediatric)          Neurosonology                    Breast

        Registry Numbers (all applicable): ARDMS _____________ CCI _______________ ARRT ______________

        Please check all specialty areas in which you are currently practicing:
          Abdomen          Breast                        Cardiac (Adult)          Cardiac (Pediatric)            Cardiac (Fetal)    Neurosonology
          Ob/Gyn           Ophthalmic Biometry           Ophthalmology            Vascular                       Veterinary

        Registrations/Certificates you hold (please check all that apply):                                                NOTE:
          RDMS                  RDCS                   RVT                 RPVI                                           This application
          RVS                   RCS                                                                                       valid through
          RT(CV)                RT(M)                  RT(S)               RT(VS)                   RT(BS)                12/31/10
          MD                    DO                     RN                  ROUB

        Please check all specialty areas in which you are registered or certified:
          Abdomen          Breast                        Cardiac (Adult)          Cardiac (Pediatric)            Cardiac (Fetal)    Neurosonology
          Ob/Gyn           Ophthalmic Biometry           Ophthalmology            Vascular

        Highest educational level completed:
          Bachelor’s Degree             Master’s Degree              Doctorate




                 SDMS Office Use Only:

                 Member Number: ____________              Payment Type: ___________                 Amount: ___________

                 Batch and/or
                 Reference Number: ____________           Item #: ____________                      Date Received:_________________




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            APS Membership Application & Guidelines


          EDUCATION - List Bachelor’s Degree or higher only
          Degree                                                 Institution (Name & Address)                                           Date Degree Received




           ARDMS REGISTRATION - List specialty area(s) for which you are apply for APS membership
                Specialty               Date Registered                          If applicable, describe reasons for any lapse in registration.




        CLINICAL WORK EXPERIENCE - Attach extra page, if needed.
        Dates               Job Title                            Employer (Name, address, and Supervisor’s Name)                  Typical/Average Scans Per Day




        PUBLISHED ARTICLE(S)
        Journal Name                             Article Title                           Publication Date/Publication Acceptance Date             Citation




AFFIDAVIT
I, __________________________________, swear or affirm that the statements contained in this application and all
supporting documentation are to the best of my knowledge true and accurate. I further affirm that I understand that
falsification of information is a violation of the Code of Ethics for the Profession of Diagnostic Medical Sonography and will
result in rejection of my APS Membership Application. I authorize SDMS to verify the submitted membership information
by contacting employers (present and past), educational institutions, and my certification organization(s) at any time. I
understand that in order to maintain eligibility for the APS membership category, I must maintain “active” status with my
certification organization(s), and I will provide SDMS with documentation to verify my continued compliance with APS
membership category requirements each year at membership renewal. I also understand that the one-time processing fee
is non-refundable and any dues assessed for APS Membership upon application approval are non-refundable and can not
be transferred.


__________________________________________________ ___________________________________________
(Applicant Signature)                                                                     (Date)



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              APS Membership Application & Guidelines


APS Membership Processing Fee
There is a one time, non-refundable processing fee for each specialty area. Please use the following chart to calculate the
appropriate fee to submit with your APS Membership Application. Write the specialty area(s) in which you are applying for
APS membership in the column on the left. The column on the right indicates the processing fee for each specialty area.
The “Total” is the sum of fees for each specialty area for which you are applying. The “Total” is the amount you should
submit with your APS application and other required documentation.


                                                  APS Specialty Area                      Application Fee

                                             1.                                                           $20 USD
                                             2.                                                       + $20 USD
                                                                                                Total $ ______ USD




        Payment Method
        Please indicate payment method (US dollars drawn on US bank):

           Check #____________                                         Money Order

             Charge:                   $20         $40   to:
           American Express                          Discover                  MasterCard                         Visa

        Credit Card Number _______________________________________________ Expiration Date ____________

        Cardholder’s Name________________________________Signature _________________________________
        (as it appears on card)

        Cardholder’s Billing Address __________________________________________________________________
        (as it appears on statement)                                      (Please include address, city, state/province/country, and zip+4/postal code)




APS Membership Dues
Initial Payment
Once your APS membership has been approved, your initial dues payment will be calculated based on the following
criteria: 1) your current SDMS expiration date, and 2) your APS membership date of approval. Do not send a dues
payment with your APS membership application. You will be billed for the appropriate dues once your membership has
been approved.


Annual APS Renewal
Each year, prior to your annual anniversary date, you will be billed for annual APS dues. The APS dues are: $179 USD

Membership dues to the SDMS are not deductible as a charitable contribution for U.S. Federal tax purposes, but may be partially deductible as a
business expense. The SDMS estimates 15% of your dues are not deductible because of the SDMS’ lobbying activities on behalf of its members.




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        APS Membership Application & Guidelines



Annual Renewal Process
Each year, prior to your annual membership anniversary date, you will be billed for the appropriate APS membership dues.
At that time you will also be asked to submit documentation illustrating your continued compliance with APS membership
category requirements in clinical experience and continuing education. This documentation consists of:
         1. a properly executed APS Renewal Documentation Letter (Form APS-DL2), and
         2. copies of CME certificates outlining (required) CMEs in your specialty area(s) if records indicate a
            deficiency, and
         3. a completed copy of the APS CME Log (Form APS-CME) if a deficiency is noted.
(You may submit multiple copies of the APS CME Log if you need additional space when listing CME courses.)
The required documentation should be sent to the SDMS along with your dues payment and invoice. Membership dues
may be submitted independant of documentation to ensure no membership lapse. Failure to submit this documentation
will result in the loss of membership in the APS membership category. Membership will be converted to Active, and you
will be sent notification of this category change.
PLEASE NOTE: Do not submit renewal information prior to receiving your renewal packet by mail. Detailed instructions
regarding the renewal process will be mailed to you including any changes to the process for that membership year.




Adding APS Specialties to your Current APS Membership
You may add specialty areas to your current APS membership each year during your annual membership renewal period.
In order to achieve this you must return the following documentation with your membership renewal invoice:
         1. a letter indicating your intent to add a specialty and the date of certification for that specialty,
         2. the appropriate processing fee ($20 per specialty added),
         3. additional copies of CME certificates and completed copy of the APS CME Log (form APS-CME) indicating
            compliance with the CME requirement for that specialty area, and
         4. a properly executed APS Documentation Letter (Form APS - DL1) for the added specialty.


Please note: If you add a specialty to your APS membership, you will be required to submit a Form APS - DL1 for the new
specialty area and a Form APS - DL2 for the renewing specialty.


Note: Specialty areas may not be added to your current APS membership unless you have a Bachelor’s Degree
in Diagnostic Medical Sonography, Cardiovascular Technology, or Echocardiography.




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        APS Membership Application & Guidelines




                                    APPENDIX




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        APS Membership Application & Guidelines

APS Documentation Letter Template - APS-DL1
A properly executed copy of this letter must accompany your APS Membership Application and documentation. This letter
must be printed on institutional letterhead and the Personnel Director’s (or Supervisor or Supervising Physician) signature
must be notarized.



  (Institutional letterhead)


                                                                       APS Documentation Letter


  (Date)


  Membership Marketing & Services Coordinator
  Society of Diagnostic Medical Sonography
  2745 N Dallas Pkwy Ste 350
  Plano, TX 75093-8730

  Dear SDMS Membership Coordinator,

  This letter is to document that ___________________________________________ has the job title and job
                                                                 (sonographer’s name and ARDMS/CCI registry number)

  description of _______________________________________.
                                                     (current job title)

  I affirm that ______________________________ has satisfactorily performed his or her duties in the area(s) of
                                     (sonographer’s name)

  ____________________________________________________, maintaining a minimum of 24 hours per week of
               (List all specialty areas for which APS membership is being sought.)*

  clinical work per specialty, from _________________________ to _______________________.
                                                                              (start date)                            (current or end date)

  I further affirm that ___________________________________ has satisfactorily performed or supervised at least 800
                                                          (sonographer’s name)

  sonographic examinations per year per APS specialty during this time.


  I, __________________________________________________, affirm that the above statements are true based on
              (Personnel Director’s (or Supervising Physician in a private clinic) name

  past employment and work experience only at the institution listed on this letterhead.


  __________________________________________________________
  Personnel Director’s (or Supervisor or Supervising Physician) Signature and Title


  __________________________________________________________
  Notary Seal, Signature, and Date




* Abdomen, Adult Cardiac, Breast, Neurosonology, Ob/
  Gyn, Opthalmology, Pediatric Cardiac, Vascular.                                                                                             APS-DL1




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        APS Membership Application & Guidelines

APS Renewal Documentation Letter Template - Form APS-DL2
A properly executed copy of this letter must accompany your SDMS APS membership renewal. This letter must be
printed on institutional letterhead, signed by your Personnel Director’s (or Supervisor or Supervising Physician) and by
you. Your signature must be notarized.



  (Institutional letterhead)

                                                                       APS Documentation Letter

  (Date)


  Membership Marketing & Services Coordinator
  Society of Diagnostic Medical Sonography
  2745 N Dallas Pkwy Ste 350
  Plano, TX 75093-8730

  Dear SDMS Membership Coordinator,

  This letter is to document that ___________________________________________ has the job title and job
                                                                 (sonographer’s name and ARDMS/CCI registry number)

  description of _____________________________________.
                                                     (current job title)

  I affirm that ______________________________ has satisfactorily performed his or her duties in the area(s) of
                                     (sonographer’s name)

  ____________________________________________________, maintaining a minimum of 24 hours per week of
               (List all specialty areas for which APS membership is being sought.)*

  clinical work per specialty, from _________________________ to _______________________.
                                                                           (start date)                          (current or end date)

  I further affirm that ___________________________________ has satisfactorily performed or supervised at least 800
                                                           (sonographer’s name)

  sonographic examinations per year per APS specialty during this time.


  I, __________________________________________________, affirm that the above statements are true based on
             (Personnel Director’s (or Supervising Physician in a private clinic) name

  past employment and work experience only at the institution listed on this letterhead.


  __________________________________________________________
  Personnel Director’s (or Supervisor or Supervising Physician) Signature and Title


  I, the undersigned, swear or affirm that the statements contained in this document are to the best of my knowledge
  true and accurate. I further affirm that I understand that falsification of information is a violation of the SDMS Code
  of Ethics and will result in rejection of my APS membership renewal.

  __________________________________________________________
  SDMS APS Member’s Signature, and Date



  __________________________________________________________
  Notary Seal, Signature, and Date


                                                                                                                                         APS-DL2
* Abdomen, Adult Cardiac, Breast, Neurosonology, Ob/
  Gyn, Opthalmology, Pediatric Cardiac, Vascular.


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         APS Membership Application & Guidelines

APS CME Log Template - Form APS-CME
Please use the following chart to outline your CME credits required for APS membership. NOTE: Documentation of (15)
CME credits is required for each APS specialty area. For New Membership: See step 4 of the Application Process for
use of this form. For Membership Renewal (if deficient): ONLY credits earned 3 years prior to your current APS Member-
ship expiration are valid for use during the renewal period. This form MUST be accompanied by copies of CME certificates
acceptable by your certification organization; which fulfill the APS CME requirement.

Name: _______________________________ Specialty 1: _________ Specialty 2: _________ Specialty 3: _________

        Date        Specialty*                                    Title of Course                                               Credit Hours
                                                                                                                                in Specialty
   01/01/2000             OB                 1st Annual Preconvention & Convention for Ultrasound                                       2.5
    (Sample)           (Sample)                                    (Sample)                                                          (Sample)




* AB=Abdomen (includes Small Parts) AE = Adult Cardiac   BR = Breast   PE = Pediatric Cardiac   NE = Neurosonology   OB = Obstetric/Gynecology
  OP = Opthalmology VT = Vascular Technology

I, the undersigned, swear or affirm that the statements contained in this                          Total CMEs for specialty 1: __________
document are to the best of my knowledge true and accurate. I further
affirm that falsification of information is a violation of the SDMS Code                           Total CMEs for specialty 2: __________
of Ethics and will result in rejection of my APS Membership Renewal.
                                                                                                   Total CMEs for specialty 3: __________
_________________________________________________________
SDMS APS Member’s Signature                                                 Date

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         APS Membership Application & Guidelines


                                          Employment Documentation
This form may be used in lieu of the required APS Documentation Letter only if your employment records with a previous employer are
completely inaccessible or destroyed. This information will be verified.

1. APS Applicant’s Name: _________________________________________________________________________

2. Maiden Name (if applicable):_______________________________ SDMS Member # (if applicable) ____________________

3. Address:_____________________________________________________________________________________
                  Street                                   City                          State/Province                   Zip+4/Postal Code      Country

4. Name and last known address of company: _________________________________________________________

_______________________________________________________________________________________________

5. Reason for inability to obtain employment records:   Company out of business (date ____________________)
  Other (Please specify________________________________________________________________________)

6. Dates of employment at this company: From _____ / _____ / ________ to _____ / _____ / ________

7. Job Title during your employment: ________________________________________________________________

8. Immediate Supervisor during this time period: _______________________________________________________
                                                                                  (Print First and Last Name and Title)

9. How many hours per week did you perform ultrasound examinations? ___________________________________

10. In which specialty area(s) are you applying for APS membership?
            Abdomen            Cardiac (Adult)         Ophthalmology             Vascular
            Ob/Gyn             Cardiac (Pediatric)     Neurosonology             Breast

11. How many hours per week did you perform ultrasound examinations in your first APS specialty?_________
     How many scans did you perform in this specialty per year? _____________

12. If applicable, how many hours per week did you perform ultrasound examinations in your second APS
    specialty? ____________
       How many scans did you perform in this specialty per year? _____________

13. If applicable, how many hours per week did you perform ultrasound examinations in your third APS
    specialty? ____________
       How many scans did you perform in this specialty per year? _____________


I, the undersigned, swear or affirm that the statements contained in this document are to the best of my knowledge true
and accurate. I further affirm that I understand that falsification of information is a violation of the SDMS Code of Ethics
and will result in rejection of my APS Membership Application.



__________________________________________________ __________________________________
Applicant’s Signature                                                  Date


__________________________________________________________
Notary Seal, Signature, and Date



                                                                                                                                              APS-ED1



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