3rd Anual Medical Response to Child Abuse and Neglect at Stanford

October 17, 20145:30 AM1:00 PM PDT

Li Ka Shing Center for Learning and Knowledge, Stanford University

3RD ANNUAL MEDICAL RESPONSE TO CHILD ABUSE AND NEGLECT October 17, 2014 Li Ka Shing Center for Learning and Knowledge, Stanford, CA
	ENROLLMENT APPLICATION 3rd Annual Medical Response to Child Abuse and Neglect – October 17, 2014 Please register by completing this application form or by register- ing online at http://cme.stanford.edu/childabuse/. Applications must be completed online, faxed or postmarked 3 weeks prior to the course date. Registration fee includes continental breakfast, refreshment break, lunch, course materials, and certificate of atten- dance. Tuition may be paid by check, Visa or MasterCard. Please type or print: ____________________________________________________________ NAME/DEGREE ____________________________________________________________ SPECIALTY ____________________________________________________________ MEDICAL LICENSE NUMBER (REQUIRED FOR CME CREDIT) AFFILIATION ____________________________________________________________ STREET ADDRESS ____________________________________________________________ CITY STATE ZIP ____________________________________________________________ BUSINESS PHONE FAX _____________________________________________________________ EMAIL CONCURRENT SESSION CHOICES: Please mark one choice each for Session I and Session II: Breakout Session I: Breakout Session II: REGISTRATION FEES: CSEC Youth in the Office Practice Defining Medical Neglect Domestic Violence Medical Child Abuse Adverse Childhood Experiences Sexual Abuse in Adolescents $125 Check made payable to Stanford University School of Medicine Physicians Nurses & Allied Health Professionals $75 Type of payment: Credit Card (Check one: Visa Master Card) ____________________________________________________________ CARD NUMBER EXPIRATION ____________________________________________________________ NAME (AS IT APPEARS ON CARD) ____________________________________________________________ CARDHOLDER’S SIGNATURE Please register online at http://cme.stanford.edu/childabuse/ OR complete this form and remit with payment to: Stanford Center for Continuing Medical Education Attn: Jean Hengst 1070 Arastradero Road, Suite 230, Palo Alto, CA 94304 Phone650)497-8554 Fax650)497-8585 Email: stanfordcme@stanford.edu Stanford University School of Medicine is fully ADA compliant. If you have needs that require special accommodations, includ- ing dietary concerns, please contact stanfordcme@stanford.edu CONFERENCE LOCATION Li Ka Shing Center for Learning and Knowledge 291 Campus Drive, 2nd Floor Stanford, CA 94305 http://lksc.stanford.edu/ For questions about the symposium, please contact Jean Hengst, Stanford Center for Continuing Medical Education at (650) 497-8554 or email stanfordcme@stanford.edu.
STATEMENT OF NEED This CME symposium will address the need of medical practitio- ners treating pediatric patients to increase and improve the fund of knowledge regarding child abuse and neglect, increase awareness of this issue and available resources and to increase comfort level in screening and treating these patients. This course will offer prac- tical strategies on implementing these skills in the clinical practice. TARGET AUDIENCE This regional conference is designed to meet the educational needs of physicians across all specialties, nurse practitioners, nurses, social workers, lawyers, and law enforcement officers. LEARNING OBJECTIVES At the conclusion of this activity, participants should be able to: Develop skills to recognize and treat child abuse in clinical prac- tices according to evidence-based guidelines. Develop skills and strategies to consistently and timely docu- ment and report suspected child abuse. Apply the multi-disciplinary approach to treat and protect abused children. ACCREDITATION The Stanford University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. CREDIT DESIGNATION Stanford University School of Medicine designates this live activity for a maximum of 5.5 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. The California Board of Registered Nursing recognizes that Con- tinuing Medical Education (CME) is acceptable for meeting RN continuing education requirements, as long as the course is certi- fied for AMA PRA Category 1 Credit(s)TM (rn.ca.gov). Nurses will receive a Certificate of Attendance following this activity that may be used for license renewal. The Lucile Packard Children’s Hospital Department of Social Ser- vices is accredited by the California Board of Behavioral Sciences, Continuing Education Provider number PCE3981. This course meets the qualifications for 5.5 hours of continuing education credit for LMFTs, LPCCs, LEPs, and/or LCSWs as required by the California Board of Behavioral Sciences. CANCELLATION POLICY Refunds must be requested in writing 3 weeks prior to the course and will be subject to a $25 administrative fee. No refunds will be made on cancellations received after this date. Program materials cannot be guaranteed unless enrollment is received at least 3 weeks prior to the course. Stanford University School of Medicine reserves the right to cancel this program; in the event of cancellation, course fees will be fully refunded. ACCOMMODATIONS Nearby Hotels with free shuttle to campus: Sheraton (650) 328- 2800; Westin (650) 321-4422. Please contact the hotel directly to secure a reservation.
To register and pay online, visit http://cme.stanford.edu/childabuse/