H O U S E O F D E L E G A T E S A N N U A L S C I E N T I F I C M E E T I N G

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June 24-28, 2013

C O N R A D S A N J U A N C O N D A D O P L A Z A S A N J U A N , P U E R T O R I C O

P A T I E N T S A F E T Y R I S K M A N A G E M E N T : W H A T E V E R Y P H Y S I C I A N S H O U L D K N O W

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H O U S E O F D E L E G A T E S A N N U A L S C I E N T I F I C M E E T I N G

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InvItatIon to aaPS DIPlomateS, memberS, anD ColleagueS

You are cordially invited to join your fellow Diplomates, Members, and Other Health-Care Professionals

For discussions and up-to-date information on Patient Safety & Risk Management: What Every Physician Should Know

Monday, the Twenty-Fourth of June through Friday, the Twenty-Eighth of June, Two Thousand Thirteen

AdvAnce Your cAreer!network! LeArn! reLAx & enjoY!Attend the 2013 AnnuAL Meeting!

greAt hoteL in greAt LocAtion• Easy access from many US cities

• Discover the sophisticated style of Conrad San Juan Condado Plaza where tropical luxury beckons

• Close to Old Town San Juan, shopping, dining, the beach, and more

FLexibLe options• Customize your schedule – choose the sessions that work for you -

the Business Package or the CME Package.

new this YeAr - bedside uLtrAsound workshop

• Choose from two sessions – Wednesday, June 26, or Friday, June 28

greAt pricing• Registration packages allow you to pay only for

the portion of the meeting you plan to attend.

• Welcome Reception included in all packages.

generous deAdLines• Take advantage of best prices during Early

Registration THIS IS YOUR BEST BUY!!!• Early Registration up to March 22, 2013

• Still-Time-To-Register up to May 31, 2013

overALL Meeting objectives• Provide physician specialists with up-to-date information about

Patient Safety & Risk Management.

• Provide a forum in which to discuss developing and emerging issues in your specialty or sub-specialty.

• Plan and conduct business that will further strengthen the mission of the AAPS, its affiliated Academies of Medicine, and its Boards of Certification.

• Encourage collegial relations that enable individual members to pursue their professional goals of participation in the Association’s activities.

intended AudienceABPS Diplomates and AAPS Members in:

Anesthesiology

Dermatology

Diagnostic Radiology

Disaster Medicine

Emergency Medicine

Family Medicine Obstetrics

Family Practice

Geriatric Medicine

Hospital Medicine

Internal Medicine

Obstetrics & Gynecology

Ophthalmology

Orthopedic Surgery

Plastic & Reconstructive Surgery

Psychiatry

Radiation Oncology

Surgery

Urgent Care Medicine

AccreditAtion stAteMentThe American Association of Physician Specialists, Inc. is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

cMe credit stAteMentExamination Development Workshop I, June 24 – The AAPS designates this test-item writing activity for a maximum of 7 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Examination Development Workshop II, June 25 – The AAPS designates this test-item writing activity for a maximum of 5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

2013 Annual Scientific Meeting – June 26 and 27: The AAPS designates this live activity for a maximum of 16 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

eArn cMe credits bY pArticipAting in . . . Up to 16.0 CME credits for Scientific Presentation sessions

Up to 12.0 CME credits for Examination Development Workshops

Up to 7.5 CME credits for Medical Ethics course

Up to 7.75 CME credits for Ultrasound Workshop

cMe coMMitteeKenneth M. Flowe, M.D., FAAEP, MBA, Co-Chair

Stephen A. Montes, D.O., FAASOS, Co-Chair

Muhammad A. Ahmed, M.D.

Lingappa S. Amernath, M.D.

Jack V. Greiner, D.O., PhD, FAASS, MA

Surinder K. Kad, M.D., FAAIM, MPH, MBA

Jerry R. Majers, D.O., FAAIM, FAAGM

Herbert Pardell, D.O., FAAIM

Luis M. Velasco, M.D.

bedside uLtrAsound workshop7.75 cMe credits

sepArAte registrAtion required $799.00one-dAY course: wednesdAY, june 26FridAY, june 28

bedside uLtrAsound hAs been shown to:• Quicken diagnoses

• Enhance patient management

• Rule in/out emergent conditions

• Decrease procedural complications

• Increase patient satisfaction

AccreditAtion stAteMent

The American Association of Physician Specialists, Inc., (AAPS), is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

cMe credit stAteMent The American Association of Physician Specialists, Inc., designates this live activity for a maximum of 7.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

registrAnts wiLL: • Learn Bedside Ultrasound from the experts

• Participate in lectures from top experts in the field

• Practice at hands-on stations with maximal benefit – 1 instructor per 5 registrants

• Review basic bedside ultrasound applications including:

• Rapid Ultrasound in Shock (RUSH) protocol

• Extended FAST scan for trauma and unexplained hypotension

• Focused echocardiography for contractility and pericardial effusion assessment

• Aorta evaluation for abdominal aneurysm

• Renal assessment for hydronephrosis

• IVC evaluation for volume status

• Gallbladder assessment for gallstones and cholecystitis

• Thoracic ultrasound for pneumothorax/pleural effusion/pneumonia assessment

• Two-point DVT evaluation

• Orbital/ocular ultrasound for retinal detachment/vitreous hemorrhage/ocular trauma

• Also review ultrasound guided central and peripheral IV access with the ability to practice this important technique on gel models.

• Question and answer session

MedicAL ethics: prActicAL issues And ApproAches

7.5 cMe credits

sepArAte registrAtion required $450.00one-dAY course: FridAY, june 288:00 AM to 5:00 pM

This course provides a solid conceptual grounding in medical ethics, while focusing on practical issues and tested approaches for resolving such issues. This course satisfies a professional development requirement for fulfilling, in part, Board recertification of the American Board of Physician Specialties of the American Association of Physician Specialists.

course objectivesUpon completion of this program participants should be able to:

1. Understand the theoretical and historical foundations of medical ethics;

2. Engage in allocation of resources decisions;

3. Apply ethical decision-making tools to actual circumstances;

4. Understand the appropriate roles of medical ethics/bioethics committees and be able to constructively contribute to these committees;

5. Recognize the stakeholders in medical ethics decisions and weigh stakeholder ethical perspectives; and

6. Guide public discussion of medical ethics issues and explain the perspectives of medical professionals on such issues.

AccreditAtion stAteMent

The American Association of Physician Specialists, Inc. is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

cMe credit stAteMent The American Association of Physician Specialists, Inc., designates this live activity for a maximum of 7.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

recertiFicAtion credit

This course fulfills ABPS recertification requirements for Medical Ethics. CME credit earned for attending this course may also be applied to the CME recertification requirements.

scheduLe oF events

sundAY, june 2312 noon – 5:00 pm ....... Registration Desk1:00 pm – 5:00 pm ....... Emergency Medicine Credentialing OPEN TO BOC MEMBERS/CREDENTIALING COMMITTEE ONLY2:00 pm – 5:00 pm ....... Strategic Planning Meeting

MondAY - FridAY 7:00 am – 5:00 pm .........Registration7:00 am – 8:00 am .........Breakfast

MondAY, june 247:30 am – 11:30 am ..... AAPS Board of Directors Meeting OPEN TO EVERYONE7:45 am – 1:00 pm ....... Auxiliary-sponsored trip to El Yunque Rainforest 8:00 am – 5:00 pm ....... Examination Development Workshop I – All Specialties OPEN TO DIPLOMATES ONLY8:00 am – 5:00 pm ....... Credentialing – All Specialties OPEN TO BOC MEMBERS/CREDENTIALING COMMITTEE ONLY11:30 am – 1:00 pm ..... Lunch on your own1:00 pm – 3:00 pm ....... House of Delegates3:00 pm – 4:15 pm ....... Council of Academy Presidents Meeting3:00 pm – 5:00 pm ....... American Board of Physician Specialties (ABPS) Meeting5:30 pm – 7:00 pm ....... Welcome Reception

tuesdAY, june 258:00 am – 9:15 am Academies of Medicine Meetings (ANESTHESIOLOGY, EMERGENCY MEDICINE, FAMILY PRACTICE, INTERNAL MEDICINE, ORTHOPEDIC SURGERY, RADIOLOGY, SURGERY)8:00 am – 9:15 am Boards of Certification Meetings (FAMILY MEDICINE OB, URGENT CARE)9:00 am – 11:00 am ..... Auxiliary Brunch and Meeting9:30 am – 11:00am Boards of Certification Meetings (ANESTHESIOLOGY, EMERGENCY MEDICINE, FAMILY PRACTICE, INTERNAL MEDICINE, ORTHOPEDIC SURGERY, RADIOLOGY, SURGERY)

11:00 am – 12 noon ..... Membership Committee Meeting11:00 am – 12 noon ..... Governmental Affairs Committee Meeting11:00 am – 12:30 pm ... Academy & Board Orientation12:00 noon – 1:00 pm .. Lunch on your own12:00 noon – 5:00 pm .. Examination Development Workshop II OPEN TO DIPLOMATES ONLY1:00 pm – 2:15 pm ....... American Academy of Specialists in Dermatology American Academy of Disaster Medicine1:00 pm – 2:30 pm ....... American Board of Hospital Medicine1:15 pm – 2:30 pm ....... CME Committee Meeting2:30 pm – 3:45 pm ....... AJCM Editorial Board Meeting 2:30 pm – 4 :00pm ....... Board of Certification in Dermatology American Board of Disaster Medicine AAPS Foundation4:00 pm – 5:15 pm ....... Past Presidents Meeting6:15 pm – 7:00 pm ....... President’s Reception7:00 pm – 10:00 pm ..... President’s Awards Dinner

wednesdAY, june 268:00 am – 5:00 pm ....... Bedside Ultrasound Workshop OPEN TO DIPLOMATES ONLY8:00 am – 5:30 pm ....... CME Scientific Presentations 12:00 noon – 1:00 pm .. Bedside Ultrasound Lunch12:00 noon – 1:30 pm .. CME Lunch

thursdAY, june 278:00 am – 5:00 pm ....... CME Scientific Presentations 12:00 noon – 1:00 pm .. CME Lunch

FridAY, june 288:00 am – 5:00 pm ....... Medical Ethics Course8:00 am – 5:00 pm ....... Bedside Ultrasound Workshop12:00 noon – 1:00 pm .. Bedside Ultrasound Lunch12:30 pm – 1:30 pm ..... Medical Ethics Lunch

All meetings and events are open to all attendees unless noted otherwise on the schedule. Schedule is subject to change beyond the control of AAPS.

speAkers

MuhAMMAd A. AhMed, M.d.There is a Medical App for That

LingAppA s. AMernAth, M.d.New Technology Improving Patient Safety

Arthur L. berMAn, d.o., FAAiMPreventing Transmission of Hepatitis B and C in Healthcare Providers

pAuL bLAndo, M.d.Accurate Measurement of O2 Saturation in Acute Acquired Methemoglobinemia (AAM)

joseph M. dAMiAni, M.d., FAAprs Code Pink Infant Abduction

jAck v. greiner, d.o., phd, FAAssPreserving the Ocular Surface’s Role as a Barrier to Infection

surinder k. kAd, M.d., FAAiM, Mph, MbAThe Fen-Phen Debacle

AMY kALekAScreening for Psychosocial Stressors in Pregnant Patients: Are There Improved Maternal and Child Outcomes?

oMoFoLAsAde b. kosoko-LAsAki, M.d.Domestic Violence and its Ocular Manifestations

jAMes MorgAn kYLe, M.d.Sports Concussion Management – Safe Return to Play

speAkers

MArk t. LoAFMAn, M.d., MphIntegrated Medication Management: Moving Beyond Medication Reconciliation . . .

Preparing for Obstetrical Hemorrhage . . .

LesLie MukAu, M.d., FAAep, FAcepApplying Lean Methodology and Current Best Practices to Emergency Department Operations . . .

Reducing Risk of Radiation Exposure from Computed Tomography: New Perspectives in Improving Patient Safety

MArk pAstin, ph.d.Risk and Responsibility

MAdonnA ringswALd, d.o., FAAiMTeach-Back Method: Preventing Readmissions and Medication Errors

eduArdo schoLcoFF, M.d.Pregnant Trauma in the ER: New Tools for Better Outcomes

jAMes w. terbush, M.d., Mph Health Consequences of a Cyber Event: A Real Risk to Patient Safety

dAnieL Y. wAng, M.d. How Does Medical Board Investigate If Being Sued?

AccoMModAtionsconrAd sAn juAn condAdo pLAzAoffers guests a breathtaking beachfront location - the ideal setting for an island getaway with endless choices in entertainment and relaxation.

Located close to the airport and within minutes of the historic heart of the island’s capital

999 Ashford Ave. San Juan, PR 00907Hotel Direct: 787-721-1000 | Reservations Direct: 787-721-1000 X 2030 and 2031Hilton Reservations: 800-HILTONS | Fax: 787-722-7955

Group code: ACMZ www.condadoplaza.com

hoteL reservAtionsAAPS has a limited number of rooms available at this rate so we encourage you to make your reservations now. The group rate will be available until MAY 30, 2013, OR until the group block is sold out, whichever comes first.

NOTE: Please let the AAPS Meetings Department know if you do not make your reservation directly with the hotel – either through the hotel website or hotel reservations. Reservations made outside of this method will be counted toward our hotel room obligation – if you let us know you have made them.

• Single or double occupancy $159 (approximately $207 including all taxes)

• Children in same room with parents: Free

• Guaranteed room rate applies three days before and three days after meeting, based on availability at the time of the request.

• Check-in 4:00 pm | Check-out 12:00 noon

• Hotel cancellations must be made 72 hours prior to day of arrival to avoid cancellation fee.

Any problems making hotel reservations, call the AAPS Meetings Department immediately.

hoteL AMenities

beAch/pooL Refresh your senses in the shimmering waters of Puerto Rico. With three outdoor pools, whirlpool, and a magnificent beachfront, you will be captivated by unbelievable views and surprising indulgences. Immerse yourself in the comfort of the saltwater pool or enjoy a workout in the lap and lounging Lagoon Pool.

wAter sports Features kayak and stand-up paddle board rentals, snorkeling.

the Fitness center Keep your workout routine in the state-of-the-art Fitness Center, featuring sauna and steam room - open 24 hours.

spA Nearby – Zen Spa – www.zen-spa.com and Olas Spa at the Caribe Hilton Hotel.

gAMes Join in the fun of the daily activities program. Table games, balls and other recreational toys are available on request.

tennis courts Test your skill on the hotel’s two lighted tennis courts. Lessons are available.

goLF See Dorado Beach at www.doradobeachclubs.com.

cAsino Play a hand of blackjack in the 24-hour Condado Casino.

restAurAnts Five onsite restaurants, three lobby bars.

neArbY AttrActions & shopping Puerto Rico is known for its stunning beaches, extraordi-nary landscapes, friendly people, delectable dining, and exciting nightlife and gaming.

The Conrad San Juan Condado Plaza is within minutes of the historic heart of the island’s capital. Old San Juan has a high concentration of museums, stores, and art galleries. Take a step back in time as you stroll along historic cobblestone streets and admire the colonial architecture. Browse the high-end shops – just minutes from your door. Be sure to visit the Bacardi Rum Distillery, Pablo Casals Museum, the El Morro Fortress, and the Pharmacy Museum.

cLiMAte And cLothing: Be prepared for hot days and cool nights - 82° days and 78° nights. Check local listings to determine weather conditions.

Casual clothing is recommended both in and out of the meeting rooms with the exception of the President’s dinner when a jacket and tie for men (black tie is optional) and corresponding attire for women is requested. You may want to bring clothing to accommodate all meeting room temperatures.

heLpFuL website www.enjoypuertorico.com

trAveL inForMAtion

Airport: Luis Munoz Marin (SJU) is located approximately seven miles and 15 minutes from the hotel.

Airport trAnsportAtion: Transportation to the hotel is available in the airport shuttle area. Taxis are approximately $15 + luggage and gratuity.

hoteL pArking: Valet parking $20 plus tax per day. Self-parking $15 plus tax per day.

speciAL AAps – hertz rentAL rAte: You can make reservations online at Hertz.com or call Hertz directly at 800-654-2240. Use AAPS code CV# 04SW0002. Meeting rate is guaranteed from one week prior through one week after the meeting dates and is subject to availability.

deAr AuxiLiArY MeMbers And guests:Welcome to the 2013 AAPS Annual Meeting. I hope you will join us at the luxurious Conrad San Juan Condado Plaza for some fun and sun as we relax poolside, try one of several on-site restaurants, or try your luck at San Juan’s largest 24-hour casino, located within the hotel.

Join us on Monday, June 24, for an exciting ½ day walking tour (7:45 am to 1 pm) of the El Yunque Rainforest. This activity is free for all current Auxiliary members and their immediate family members (children and grandchildren 18 year of age and younger and spouse/significant other). For guests not currently active Auxiliary members,

admission is $59 per person, including your transportation and admission to the tour. Advance Registration is required. You can sign up on the Registration Form in this brochure. Bring your camera, comfortable shoes, and a hat.

Monday evening is the Auxiliary-sponsored Welcome Reception with a Latin theme. Everyone is welcome to attend the Auxiliary’s annual brunch at 9 am on Tuesday followed by a brief business meeting.

Renew old acquaintances, build new friendships, encourage your spouse, and support the AAPS Foundation. Make the AAPS Annual Scientific Meeting a family vacation event!

Hope to see you there!

Linda RussoPresidentAAPS Auxiliary

• Open to all family members

• Auxiliary dues are $60 per year

• Auxiliary-sponsored half-day trip to El Yunque Rainforest Monday, June 24 – meet in lobby at 7:45 am

• Welcome Reception Monday, June 24, 5:30 – 7 pm, sponsored by the AAPS Auxiliary

• Annual Auxiliary Meeting and Brunch Tuesday, June 25, at 9 am

AAps AuxiLiArY

ImPortant regIStratIon InformatIon1. To be officially registered, all fees must be paid in full prior to the appropriate

deadlines: Early Registration by March 22, 2013, or Still-Time-Register by May 31, 2013.

2. All registrations received after May 31, 2013, including On-Site, must be paid in full prior to admission to any AAPS activities. Late/On-Site Registration will be accepted by CREDIT CARD ONLY.

3. There are no exceptions to the fees and deadlines.

4. No one will be admitted to any business sessions, CME sessions, breakfast, lunch, or President’s Awards Dinner without a valid badge.

TWO REGISTRATION PACKAGES

BUSINESS: Includes all meetings – Board of Directors, Academies of Medicine, Boards of Certification, House of Delegates, Committees, Examination Development Workshops (up to 12 CME credits) and any other scheduled business meetings; conference materials; and breakfast on Monday, June 24, and Tuesday, June 25. Two days – see pricing on registration form.

CME: Includes up to 16 CME credits for scientific presentations, conference materials, breakfast, and lunch on Wednesday, June 26, and Thursday, June 27. Two days – see pricing on registration form.

ADDITIONAL OPTIONS

WELCOME RECEPTION ON JUNE 24: All tickets are free – sponsored by the AAPS Auxiliary. However, you must register in order to save your place.

PRESIDENT’S DINNER ON JUNE 25: Per ticket $125.

BEDSIDE ULTRASOUND WORKSHOP: Includes one-day course on Wednesday, June 26, or Friday, June 28, course materials, up to 7.75 CME credits, breakfast, and lunch. One-day-course – $799.

MEDICAL ETHICS: Includes one-day course on Friday, June 28, course materials, up to 7.5 CME credits, breakfast, and lunch. One-day-course – $450.

There are four member categories: DIPLOMATE/EMERITUS/MEMBER PRESENTER AAPS RETIRED NON-MEMBER CME ONLYThere are three registration deadlines: EARLY REGISTRATION – BY MARCH 22, 2013 STILL-TIME-TO-REGISTER – BY MAY 31, 2013 LATE/ON-SITE REGISTRATION – AFTER MAY 31, 2013

There are two registration packages: BUSINESS/GOVERNANCE ONLY CME/EDUCATION ONLYThere is one Medical Ethics course: FRIDAY, JUNE 28, 2013 There are two Bedside Ultrasound Workshops: WEDNESDAY, JUNE 26, 2013 FRIDAY, JUNE 28, 2013

registrAtion inForMAtionAll attendees MUST REGISTER for the 2013 House of Delegates and Annual Scientific Meeting in order to attend any sessions including business meetings, continuing medical education activities, and/or certification examination development workshops.

To complete registration for the 2013 Annual Meeting, ALL FEES MUST BE PAID IN FULL IN ADVANCE. See Registration Form for specific information.

Every effort will be made to ensure that the published schedule, as stated in the brochures, will be followed. However, changes beyond AAPS control may occur. AAPS is not responsible for notifying registrants of program changes prior to the meeting.

CONFIRMATION OF REGISTRATION: A confirmation packet will be mailed within two (2) weeks of receipt of your registration form and PAID IN FULL registration fees. Please retain copies of your registration information. If you do not receive a confirmation packet within two weeks, please contact the AAPS Meetings Department immediately.

MEETING ATTENDANCE AND CANCELLATION POLICY: ALL PERSONS ATTENDING AAPS MEETINGS ARE REQUIRED TO REGISTER AND PAY THE APPROPRIATE REGISTRATION FEE IN ADVANCE REGARDLESS OF PURPOSE OR THE NUMBER OF MEETINGS ATTENDED. Written cancellations must be received by the AAPS Meetings Department prior to April 15, 2013, in order to receive a full refund of Meeting Registration Fees, less a $150 processing fee. Cancellations received after this date will not be accepted.

PRESENTER DISCLOSURE: The American Association of Physician Specialists, Inc., believes in full disclosure. Each presenter or sponsor is required to disclose real or apparent conflicts of interest relating to topics of this educational activity. Presenter disclosure will be made to all participants in the educational activity materials and at the beginning of each presentation.

REGISTRATION FORM: AAPS 2013 HOUSE OF DELEGATES AND ANNUAL SCIENTIFIC MEETINGTO REGISTER BY FAX: 813-830-6599 (CREDIT CARD ONLY) • MAIL: AAPS, 5550 W. EXECUTIVE DRIVE, SUITE 400, TAMPA, FL 33609-1035

Name _______________________________________________________________Email Address: ____________________________________________________

Address ____________________________________________________ City ____________________________ State _____________Zip ____________________

Home phone _______________________________ Work phone ___________________________________ Cell phone ___________________________________

Packages Total $ ___________

MEDICAL ETHICS COURSE - FRIDAY, JUNE 28 .........$ 450 per person x _____ (# attending) = Medical Ethics Registration Total $ ___________BEDSIDE ULTRASOUND WORKSHOP - Select one course from below. COURSE 1 - WEDNESDAY, JUNE 26 ................. $ 799 per person x _____ (# attending) = COURSE 2 - FRIDAY, JUNE 28 .......................... $ 799 per person x _____ (# attending) = Ultrasound Workshop Registration Total $ ___________

NO ONE WILL BE ADMITTED TO ANY SESSIONS INCLUDING MEALS WITHOUT A VALID BADGE AUXILIARY RAINFOREST TOUR – MONDAY, JUNE 24 - Select from below. See AAPS Auxiliary Page for more information.

Complimentary Registration for PAID Auxiliary Members $ 0 per person x _____ (# attending) = Non-Complimentary (Paid) Registration for Non-Members $ 59 per person x _____ (# attending) = Auxiliary Rainforest Tour Total $ ___________

WELCOME RECEPTION - MONDAY, JUNE 24 ....................................$ 0 per person x _____ (# tickets) = Welcome Reception Total $ ___________(Complimentary, but you must register)

PRESIDENT’S AWARDS DINNER - TUESDAY, JUNE 25 ................. $ 125 per person x ____ (# tickets) = President’s Dinner Total $ __________

MEETING REGISTRATION PAYMENT Check enclosed American Express MasterCard Visa Grand Total to be charged: $

Cardholder’s Name ________________________________________________Card Number ______________________________ Expiration Date _______________

Cardholder’s Mailing Address ____________________________________________________ Cardholder’s Signature ______________________________________

CONSENT TO USE PHOTOGRAPHIC IMAGESRegistration and attendance at our meetings and other activities constitutes an agreement by the registrant to AAPS’s use and distribution (both now and in the future) of the registrant’s or attendee’s image or voice in photographs, videotapes, electronic reproductions and audiotapes of such events and activities.

ALL PARTICIPANTS MUST COMPLETE DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS BELOW

I DO have a relevant financial relationship with a commercial interest. (You MUST list relevant financial relationships below.)

Signature __________________________________________________________________________ Date _________________________

1. Commercial Interest (Example: Company ‘X’)

Nature of Relevant Financial Relationship (Include all those that apply)

2. What was received (Example: Honorarium) 3. For what role? (Example: Speaker)

Example Terminology

What was received: Salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit.

Role(s): Employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and other activities (please specify).

Glossary of Terms

Commercial Interest: The ACCME defines a “commercial interest” as any proprietary entity producing health care goods or services, used on, or consumed by, patients, with the exemption of non-profit or government organizations and non-health care related companies.Financial relationships: Financial relationships are those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and other activities from which remuneration is received, or expected. ACCME considers relationships of the person involved in the CME activity to include financial relationships of a spouse or partner.

Relevant financial relationships: ACCME focuses on financial relationships with commercial interests in the 12-month period preceding the time that the individual is being asked to assume a role controlling content of the CME activity. ACCME has not set a minimal dollar amount for relationships to be significant. Inherent in any amount is the incentive to maintain or increase the value of the relationship. The ACCME defines “’relevant’ financial relationships” as financial relationships in any amount occurring within the past 12 months that create a conflict of interest.Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect CME content about products or services of a commercial interest with which he/she has a financial relationship.

I DO NOT have a relevant financial relationship with a commercial interest.

Signature __________________________________________________________________________ Date _________________________

First, list the names of proprietary entities producing health care goods or services, consumed by, or used on, patients, with the exemption of non-profit or government organizations and non-health care related companies with which you or your spouse/partner have, or have had, a relevant financial relationship within the past 12 months. For this purpose we consider the relevant financial relationships of your spouse or partner that you are aware of to be yours.

Second, describe what you or your spouse/partner received (ex: salary, honorarium etc). The American Association of Physician Specialists, Inc. does NOT want to know how much you received.

Third, Describe your role.

$0.00

$0.00

TO COMPLETE THE REGISTRATION FORM DO THE FOLLOWING:

1. Review Important Registration Information.

2. Select registration package/s (Business and/or CME Package).

3. Select from Additional Options (Medical Ethics Course, Bedside Ultrasound Workshop, Auxilia-ry-Sponsored Rainforest Tour, Welcome Reception, President’s Dinner).

4. Review registration table on right and circle your registration choice. Enter fee amount in subtotal.

Member TypeRegistration

PackagesEarly Registration By Mar 22, 2013

Still-Time-To Register By May 31, 2013

Late/On-Site After May 31, 2013

AAPS Diplomate/ Emeritus/Member

Business Package $295 $495 $695

CME Package $525 $725 $925

Presenter REGISTRATION REQUIRED BY JAN. 31, 2013

Business Package $295 NA NA

CME Package $325 NA NA

AAPS RetiredBusiness Package $295 $495 $695

CME Package $325 $525 $725

Non-Member CME Package $650 $850 $1050