The American Academy of Ophthalmology in conjunction with the .rtf

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The American Academy of Ophthalmology in conjunction with the .rtf Powered By Docstoc
					                          The Ophthalmic Mutual Insurance Company
                                                       and
                the Washington Academy of Eye Physicians and Surgeons
                                                      present
                        “Responding to Unanticipated Outcomes”
Day/Date:     Tuesday, September 28, 2004                An interactive AUDIOCONFERENCE
Time:         6:00 pm - 7:00 pm                          for Washington ophthalmologists. This
Costs:        $25.00 per OMIC insured*
                                                         course will provide guidance on
              $30.00 per non-OMIC insured*
                                                         disclosure discussions, documentation,
              *Costs include handouts and toll-free      and responding to requests for refunds,
              call.                                      fee waivers, and settlements.

FACULTY:          Richard L. Abbott, MD – Member of OMIC Board of Directors and a practicing
                  ophthalmologist in San Francisco, California

                  Thomas H. Fain, Esq. – a medical malpractice defense attorney with the firm of
                  Fain, Sheldon, Anderson and VanDerhoef in Seattle, WA.

                  Anne M. Menke, RN, PhD – OMIC Risk Manager

                  Randy S. Morris, JD – OMIC Senior Claims Associate

Why an audioconference?

   Convenient and time saving: No travel time and expenses are required to participate in the
   seminar. Just call in from your office or anywhere a touch-tone phone is available. When you
   register for the seminar, we will send you a detailed handout to help you follow along with the
   presentation. You are encouraged to include your office colleagues in this important seminar.

   Interactive and fast paced: The speaker's interaction with you, the listener, will make this
   program enjoyable with Question & Answer sessions planned so that you may ask questions
   from your office.


                   YOU MUST REGISTER BY Wednesday, September 22, 2004
                        TO GUARANTEE HANDOUT MATERIALS.


       Questions? Please call Linda Nakamura at OMIC (800) 562-6642 ext. 652
                 SEE REVERSE SIDE FOR REGISTRATION INFORMATION.
                 OMIC/WAEPS Audioconference Registration Form

Objectives: After participating in the “Responding to Unanticipated Outcomes” audioconference,
ophthalmologists will be able to:
 Communicate honestly and compassionately with patients about outcomes of care.
 Handle questions about treatment provided by other physicians involved in current or prior care.
 Document care outcomes and disclosure discussions in the medical record and incident report.
 Respond to requests for refunds, fee waivers, and settlements.

                                       "This activity has been planned and implemented in accordance with the Essentials Areas
                                       and policies of the Accreditation Council for Continuing Medical Education through the
                                       joint sponsorship of the American Academy of Ophthalmology and the Ophthalmic
                                       Mutual Insurance Company. The American Academy of Ophthalmology is accredited by
                                       the ACCME to provide continuing medical education for physicians."



The Academy designates this educational activity for a maximum of 1.0 category 1 credits toward the
AMA physician’s Recognition Award. Each physician should claim only those hours of credit that he/she
actually spent in the activity.

                                       REGISTRATION FORM                        E-mail address (essential):
PLEASE TYPE OR PRINT CLEARLY.


NAME:                                                  AAO#:
______________________________________________________________________________

ADDRESS:
______________________________________________________________________________

______________________________________________________________________________

PHONE #: ______________________________ FAX #: ________________________________
COST:
I am an OMIC insured:
 Yes, $25.00   (OMIC Professional Liability Policy OMC______________________________)
 No, $30.00                                                                                    Handouts by
                                                                                                e-mail? _____
METHOD OF PAYMENT:                                                                              OR
 Check – MAKE CHECK PAYABLE TO OMIC                                                            Handouts by
                                                                                                mail? ______
 Visa       MasterCard
Account #: ___________________________________________ Expiration date: ____________

Name on card: __________________________________________________________________

Signature: ______________________________________________________________________

Return this form to: OMIC, Attn; Linda Nakamura, 655 Beach Street,
                     San Francisco, CA 94109
       FAX #:        (415) 771-1810
                           OMIC/WAEPS CD Order Form
            Please note: CD recording of the live program will be available November 2004

Objectives: After participating in the “Responding to Unanticipated Outcomes” CD, ophthalmologists will
be able to:
 Communicate honestly and compassionately with patients about outcomes of care.
 Handle questions about treatment provided by other physicians involved in current or prior care.
 Document care outcomes and disclosure discussions in the medical record and incident report.
 Respond to requests for refunds, fee waivers, and settlements.
                                       "This activity has been planned and implemented in accordance with the Essentials Areas
                                       and policies of the Accreditation Council for Continuing Medical Education through the
                                       joint sponsorship of the American Academy of Ophthalmology and the Ophthalmic
                                       Mutual Insurance Company. The American Academy of Ophthalmology is accredited by
                                       the ACCME to provide continuing medical education for physicians."

The Academy designates this educational activity for a maximum of 1.0 category 1 credit toward the
AMA physician’s Recognition Award. Each physician should claim only those hours of credit that he/she
actually spent in the activity.

                                         CD ORDER FORM
PLEASE TYPE OR PRINT CLEARLY.                                                           E-mail (essential):


NAME:                                                  AAO#:
______________________________________________________________________________

ADDRESS:
______________________________________________________________________________

______________________________________________________________________________

PHONE #: ______________________________ FAX #: ________________________________

COST:
I am an OMIC insured:
 Yes, $25.00   (OMIC Professional Liability Policy OMC______________________________)
 No, $30.00
                                                                                              Handouts by
                                                                                              e-mail? ______
                                                                                              OR
METHOD OF PAYMENT:                                                                            Handouts by
 Check – MAKE CHECK PAYABLE TO OMIC                                                          mail?________

 Visa       MasterCard
Account #: ___________________________________________ Expiration date: ____________

Name on card: __________________________________________________________________

Signature: ______________________________________________________________________

Return this form to: Linda Nakamura, OMIC, 655 Beach Street,
                     San Francisco, CA 94109
       FAX #:        (415) 771-1810

				
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