Attendee Registration Form

Transcription

1 Keynote Speakers, Stanley Surabian, DDS, JD - California Dental Practice Act ; Teresa Pichay HIPAA/ HITEC Act ; Diane Arns OSHA/Infection Control. These courses are designed for the entire dental team. The Veteran s Memorial Building. Downtown Clovis - Friday, January 18, Hughes Street, Clovis, CA :00 a.m. to 4 p.m. Attendee Registration Form Fresno-Madera Dental Society s presentation of their Winter 2013 CCDC Keynote Speakers: Stanley Surabian, DDS Teresa Pichay Diane Arns 8 C.E.U. s Fresno-Madera Dental Society 371 E. Bullard, #120 Fresno, CA PRESORTED STANDARD U.S. POSTAGE PAID Fresno, CA Permit No. 64

2

3 10 C.E. Friday, January 18, 2013 Central California Winter Dental Conference (CCDC) 8 C.E.U. s Available A presentation by the Fresno-Madera Dental Society Meeting Place: Clovis Veteran s Memorial Building 453 Hughes Street, Clovis (559) Course fees include, Friday s course, continental breakfast and lunch. Friday Morning, January 18, 2013: Stanley Surabian, DDS, JD Target audience: dentists, assistants, hygienists, and front office. Presentation: California Law : Fulfills requirement for re-licensure. Friday Morning: January 18, 2013: Teresa Pichay: HIPAA/HITEC Act Target audience: Front office, treatment coordinators dentists, assistants and hygienists. Friday Afternoon: January 18, 2013: Diane Arns OSHA and Infection Control fulfills requirement for re-licensure. Target Audience: dentists, assistants, hygienists and front office. Friday, morning, January 18, Registration 7:30 a.m. 8:00 a.m. Course 8:00 a.m.- 10:00 a.m. Clovis Veteran s Memorial Ballroom. Presenter: Stanley Surabian, DDS, JD California Law Course intended for dentists, front office, hygienists and assistants. Dr. Surabian currently serves as Chief of Dental Services, Director of the General Practice Residency Program at CMC, Division of Dentistry, Deran Koligian Ambulatory Care Center, Surabian Dental Center. He received his dental degree in 1969 from USC and his Doctorate of Jurisprudence in 1992 from the San Joaquin College of Law in Fresno. Course objectives include, but are not limited to: Understanding the Dental Practice Act; Business & Professions Code; California Code of Regulations; Laws governing the prescribing of drugs; Access to medical records; Mandatory abuse reporting. Friday morning, January :00 a.m. Noon. Presenter: Teresa Pichay HIPAA/ HITEC Act. Every office must conform. For Dentists, front office, treatment coordinators, hygienists and assistants. Course: 10:00 a.m. to 12 noon. Clovis Veteran s Memorial Ballroom Teresa Pichay is a practice analyst for the California Dental Association, having been employed there since She s written various articles and guides to help dental practices understand their regulatory compliance obligations. She is a graduate of USC. This course is designed to update the participants with the HIPAA regulations and how the new HITEC mandate expands the HIPAA Act. All offices are mandated to be in compliance with the HITEC regulations. Teresa s presentation makes this mandate easy to understand and implement in your office. The federal stimulus package, signed by President Obama on February 17, 2009 contains the Health Information Technology for Economic and Clinical Health Act (HITECH), which sets forth several changes to the Health Insurance Portability and Accountability Act (HIPAA). This course outlines the examples of how the changes may affect dentists. Your notice of privacy practices and business associate agreements should be updated to include these changes. Friday afternoon, January 18 1:00-4:00 p.m. Complete your re-licensure requirements in this OSHA and Infection Control course. For dentists, front office, treatment coordinators, hygienists, and assistants. Presenter: Diane Arns BS Diane Arns has been a speaker and consultant in the dental industry for over 10 years specializing in continuing education topics required by the Dental Board of California. She holds a Bachelor s degree in International Business from San Francisco and a clear professional teaching credential from Sacramento State. She is an approved CE provider through the Dental Board of California.

4 2013 Winter Central California Dental Conference Stanley Surabian, DDS, JD Dental Practice Act Teresa Pichay, HIPAA/HITEC Diane Arns, OSHA, INFECTION CONTROL Friday, January 18, 2013 at the Clovis Veteran s Memorial Building Ballroom 453 Hughes, Clovis (559) ADA/CDA Member $ Hygienists, RDA and DA s $ GPR Residents $ Non ADA/CDA Member $ Continental Breakfast/Vendors 7:30 a.m. 9:30 a.m. Courses run from: 8:00 a.m. 4:00 p.m. Lunch: 12:00 noon Courses conclude: 4:00 p.m. Please make sure your C.E. slips are picked up after each course. One for both morning courses, and one for the afternoon course. C.E. slips will not be mailed. Please indicate below your license, DDS, RDA, RDH, DA, or Front. All C.E. slips will be distributed at the end of each course. Parking is available on and around the premises of the Clovis Veteran s Memorial Building at no charge. Registration Dental Practice Act 7:30 a.m. Course 8:00-10:00 a.m. Registration HIPAA/HITEC Act 7:30 am Course 10:00 a.m.-12:00 noon Registration OSHA/Infection Control 1:00 p.m. Course 1:00 p.m. 4:00 p.m. Mail Completed Registration Form & payment to FMDS by January 2, 2013: 371 E. Bullard, Suite 120, Fresno, CA (559) , FAX to (559) or to fmdds@cvip.net. Call with credit card information. Registrations can also take place on our website: through PayPal. Course fees include a continental breakfast and a lunch. Please Circle One License # Street Address: City: Zip: Phone: FAX: address: Drs. (Only required if dentist is not attending) Number Attending: Amount Enclosed: Ck. # Or Amount Charged: Please charge to: Visa - MasterCard - Amer X # Expiration Date: Authorized Signature: JANUARY 18, CCDC

5 10 C.E. Friday, January 18, 2013 Central California Winter Dental Conference (CCDC) 8 C.E.U. s Available A presentation by the Fresno-Madera Dental Society Meeting Place: Clovis Veteran s Memorial Building 453 Hughes Street, Clovis (559) Course fees include, Friday s course, continental breakfast and lunch. Friday Morning, January 18, 2013: Stanley Surabian, DDS, JD Target audience: dentists, assistants, hygienists, and front office. Presentation: California Law : Fulfills requirement for re-licensure. Friday Morning: January 18, 2013: Teresa Pichay: HIPAA/HITEC Act Target audience: Front office, treatment coordinators dentists, assistants and hygienists. Friday Afternoon: January 18, 2013: Diane Arns OSHA and Infection Control fulfills requirement for re-licensure. Target Audience: dentists, assistants, hygienists and front office. Friday, morning, January 18, Registration 7:30 a.m. 8:00 a.m. Course 8:00 a.m.- 10:00 a.m. Clovis Veteran s Memorial Ballroom. Presenter: Stanley Surabian, DDS, JD California Law Course intended for dentists, front office, hygienists and assistants. Dr. Surabian currently serves as Chief of Dental Services, Director of the General Practice Residency Program at CMC, Division of Dentistry, Deran Koligian Ambulatory Care Center, Surabian Dental Center. He received his dental degree in 1969 from USC and his Doctorate of Jurisprudence in 1992 from the San Joaquin College of Law in Fresno. Course objectives include, but are not limited to: Understanding the Dental Practice Act; Business & Professions Code; California Code of Regulations; Laws governing the prescribing of drugs; Access to medical records; Mandatory abuse reporting. Friday morning, January :00 a.m. Noon. Presenter: Teresa Pichay HIPAA/ HITEC Act. Every office must conform. For Dentists, front office, treatment coordinators, hygienists and assistants. Course: 10:00 a.m. to 12 noon. Clovis Veteran s Memorial Ballroom Teresa Pichay is a practice analyst for the California Dental Association, having been employed there since She s written various articles and guides to help dental practices understand their regulatory compliance obligations. She is a graduate of USC. This course is designed to update the participants with the HIPAA regulations and how the new HITEC mandate expands the HIPAA Act. All offices are mandated to be in compliance with the HITEC regulations. Teresa s presentation makes this mandate easy to understand and implement in your office. The federal stimulus package, signed by President Obama on February 17, 2009 contains the Health Information Technology for Economic and Clinical Health Act (HITECH), which sets forth several changes to the Health Insurance Portability and Accountability Act (HIPAA). This course outlines the examples of how the changes may affect dentists. Your notice of privacy practices and business associate agreements should be updated to include these changes. Friday afternoon, January 18 1:00-4:00 p.m. Complete your re-licensure requirements in this OSHA and Infection Control course. For dentists, front office, treatment coordinators, hygienists, and assistants. Presenter: Diane Arns BS Diane Arns has been a speaker and consultant in the dental industry for over 10 years specializing in continuing education topics required by the Dental Board of California. She holds a Bachelor s degree in International Business from San Francisco and a clear professional teaching credential from Sacramento State. She is an approved CE provider through the Dental Board of California.

6 2013 Winter Central California Dental Conference Stanley Surabian, DDS, JD Dental Practice Act Teresa Pichay, HIPAA/HITEC Diane Arns, OSHA, INFECTION CONTROL Friday, January 18, 2013 at the Clovis Veteran s Memorial Building Ballroom 453 Hughes, Clovis (559) ADA/CDA Member $ Hygienists, RDA and DA s $ GPR Residents $ Non ADA/CDA Member $ Continental Breakfast/Vendors 7:30 a.m. 9:30 a.m. Courses run from: 8:00 a.m. 4:00 p.m. Lunch: 12:00 noon Courses conclude: 4:00 p.m. Please make sure your C.E. slips are picked up after each course. One for both morning courses, and one for the afternoon course. C.E. slips will not be mailed. Please indicate below your license, DDS, RDA, RDH, DA, or Front. All C.E. slips will be distributed at the end of each course. Parking is available on and around the premises of the Clovis Veteran s Memorial Building at no charge. Registration Dental Practice Act 7:30 a.m. Course 8:00-10:00 a.m. Registration HIPAA/HITEC Act 7:30 am Course 10:00 a.m.-12:00 noon Registration OSHA/Infection Control 1:00 p.m. Course 1:00 p.m. 4:00 p.m. Mail Completed Registration Form & payment to FMDS by January 2, 2013: 371 E. Bullard, Suite 120, Fresno, CA (559) , FAX to (559) or to fmdds@cvip.net. Call with credit card information. Registrations can also take place on our website: through PayPal. Course fees include a continental breakfast and a lunch. Please Circle One License # Street Address: City: Zip: Phone: FAX: address: Drs. (Only required if dentist is not attending) Number Attending: Amount Enclosed: Ck. # Or Amount Charged: Please charge to: Visa - MasterCard - Amer X # Expiration Date: Authorized Signature: JANUARY 18, CCDC