THIS COURSE IS OPEN TO PHYSICIANS ONLY

American Society of Interventional Pain PhysiciansTHE VOICE OF INTERVENTIONAL PAIN MANAGEMENT

INTERVENTIONAL TECHNIQUES

COMPREHENSIVE REVIEW COURSE AND

CADAVER WORKSHOPB A S I C A N D I N T E R M E D I AT E

Designated for 15.5 AMA PRA Category 1 Credits™

JULY 12-13, 2019 | HILTON MEMPHIS

ASIPP® EDUCATIONAL SERVICES | EXCELLENCE IN THE EDUCATION OF INTERVENTIONAL PAIN PHYSICIANS

REVIEW COURSE VENUEHILTON MEMPHIS

939 Ridge Lake Blvd, Memphis, TN 38120

Phone: 901-684-6664

CADAVER WORKSHOP VENUEMEDICAL EDUCATION &

RESEARCH INSTITUTE44 South Cleveland, Memphis, TN 38104

901-722-8001 | 800-360-6374http://www.meri.org

SPECIALS • 50% off course fee for Resident/Fellows

American Society of Interventional Pain Physicians2

INTERVENTIONAL TECHNIQUES COMPREHENSIVE REVIEW COURSE AND CADAVER WORKSHOPJULY 12-13, 2019 | HILTON MEMPHIS

YOU’RE INVITED On behalf of the Board of the American Society of Interventional Pain Physicians (ASIPP®), it is our privilege and pleasure to invite you to attend this Interventional Techniques Review Course and Cadaver Workshop. The half day didactic course is July 12 at the Hilton Memphis and the 1 1/2 day Cadaver Workshop is July 12-13 at the Medical Research Institute. Please join us. Learn. Connect. Engage.

EDUCATIONAL OBJECTIVES/TARGET AUDIENCEThis comprehensive review course and cadaver workshop for Interventional Techniques Review Course and Cadaver Workshop is targeted to interventional pain physicians seeking CME credit hours and an introduction or review of proven interventional techniques, as well as skills improvement.

EDUCATIONAL OBJECTIVES • Provide high-quality, competent, safe, accessible, and cost-efficient services to your patients• Improve existing skills and/or develop new skills in the delivery of Interventional Pain Management• Incorporate interventional techniques in treating your patients so that patients have better outcomes and reduced side effects

AMERICANS WITH DISABILITIES ACT AND SPECIAL SERVICESOrganizers fully comply with the legal requirements of the Americans with Disabilities Act and the rules and regulations thereof. If any participant in this educational activity is in need of accommodations, please contact the organizers at (270) 554-9412 at least 10 days prior to the conference.

ACCREDITATION STATEMENTThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of The Institute for Medical Studies and the American Society of Interventional Pain Physicians (ASIPP®). The Institute for Medical Studies is accredited by the ACCME to provide continuing medical education for physicians.

CATEGORY I CREDITThe Institute for Medical Studies designates the Interventional Techniques Review Course and Cadaver Workshop live activity for a maximum of 15.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ASIPP® is now an ABA Registered CME Provider.

DUPLICATION OR DISTRIBUTION OF MATERIALS OR RECORDING OF LECTURES WITHOUT EXPRESS WRITTEN PERMISSION FROM ASIPP® IS PROHIBITED. THERE IS NO COMMERCIAL SUPPORT FOR THIS COURSE.

Laxmaiah Manchikanti, MDChairman of the Board and Chief Executive Officer, ASIPP®

INVITEDFACULTYSheri Albers, DO Sacramento, CA

Joseph Cabaret, MD Camarillo, CA Kenneth Candido, MD Oak Brook, IL Hans Hansen, MD Conover, NCStandiford Helm II, MD San Clemente, CALeland Lou, MD Meridian, MS Peter Kosek, MD Eugene, OR Steve Watson, MDTampa, FL

COURSEDIRECTORS

Sudhir A. Diwan, MDPresident-Elect, ASIPP®

ACCOMMODATIONS

HILTON MEMPHIS 939 Ridge Lake Boulevard, Memphis, Tennessee, 38120TEL: 901-684-6664 | FAX: 901-762-7496

Relax and rejuvenate in a modern guest room at the Hilton Memphis hotel in Memphis, Tennessee. Keep up with a fitness routine in our Watch an on-demand movie and your choice of premium channels on a flat-screen LCD HDTV. Utilize the large work desk to catch up on tasks, and keep in touch with family or business with WiFi access.

Sheri L. Albers, DODirector at Large, ASIPP®

Hans Hansen, MDPast President, ASIPP®

American Society of Interventional Pain Physicians 3

INTERVENTIONAL TECHNIQUES COMPREHENSIVE REVIEW COURSE AND CADAVER WORKSHOP

JULY 12-13, 2019 | HILTON MEMPHIS

FRIDAY, JULY 12, 2019

REVIEW COURSE FOR INTERVENTIONAL TECHNIQUES

6:30am– 7:30am REGISTRATION AND BREAKFAST

7:30am – 11:00am Session Chair – Harold Cordner, MD

7:30am – 7:40am Introduction to Session – Harold Cordner, MD

7:40am – 8:35am Epidural Injections – Cervical, Thoracic, and Lumbar Interlaminar, Caudal, Lumbar Transforaminal & Adhesiolysis Kenneth Candido, MD

8:35am – 9:15am Facet Joint Interventions - Lumbar, Cervical, and Thoracic (Intraarticular Injections, Nerve Blocks, and Radiofrequency Thermoneurolysis) – Hans Hansen, MD

9:15am – 9:30am BREAK

9:30am – 10:00am Head and Neck Blocks – Trigeminal and Stellate Kenneth Candido, MD

10:00am – 10:30am Lumbar Discography and Sacroiliac Joint Injections Harold Cordner, MD

10:30am – 11:00am Celiac Plexus and Lumbar Sympathetic and Hypogastric Blocks – Anatomy & Technical Considerations – Leland Lou, MD

11:00am – 12:00pm LUNCH

WORKSHOP FOR INTERVENTIONAL TECHNIQUES

12:15pm Buses Leave Hotel for MERI

12:45pm – 1:45pm Introduction Lecture – Laxmaiah Manchikanti, MD

2:00pm – 5:00pm HANDS-ON CADAVER WORKSHOP

5:15pm Buses Depart MERI to Hotel

6:00pm-8:00pm DINNER AND COCKTAIL RECEPTION (non-cme lecture sponsored by Legally Mine, Inc.)

American Society of Interventional Pain Physicians4

INTERVENTIONAL TECHNIQUES COMPREHENSIVE REVIEW COURSE AND CADAVER WORKSHOPJULY 12-13, 2019 | HILTON MEMPHIS

SATURDAY, JULY 13, 2019

CADAVER WORKSHOP FOR INTERVENTIONAL TECHNIQUES

7:00am – Buses Depart Hotel to MERI

7:30am – 7:45am Registration and Breakfast

7:45am – 8:45am Introduction and Discussion – Laxmaiah Manchikanti, MD

8:45am – 12:00pm HANDS-ON CADAVER WORKSHOP 12:00pm – 1:00pm LUNCH

1:00pm – 5:00pm HANDS-ON CADAVER WORKSHOP 5:15pm Buses Depart to Hotel

CADAVER LAB LEVELS FORINTERVENTIONAL TECHNIQUES

BASIC INTERMEDIATE

1. Fluoroscopy

2. Caudal epidural injections

3. Sacroiliac joint injections

4. Lumbar interlaminar epidural injections

5. Lumbar transforaminal epidural injections

6. Lumbar facet joint nerve blocks

7. Lumbar intraarticular injections

8. Lumbar facet radiofrequency thermoneurolysis

9. Percutaneous adhesiolysis

10. Free Form

1. Fluoroscopy

2. Lumbar intraarticular injections, medial branch blocks, and radiofrequency thermoneurolysis

3. Lumbar sympathetic and hypogastric plexus blocks

4. Lumbar discography and transforaminal

5. Cervical and thoracic interlaminar epidural injections

6. Cervical intraarticular injections, medial branch blocks, and radiofrequency thermoneurolysis

7. Thoracic intraarticular injections, medial branch blocks, and radiofrequency thermoneurolysis

8. Celiac plexus blocks and stellate ganglion blocks

9. Trigeminal nerve blocks and neurolysis

10. Free Form

American Society of Interventional Pain Physicians 5

INTERVENTIONAL TECHNIQUES COMPREHENSIVE REVIEW COURSE AND CADAVER WORKSHOP

JULY 12-13, 2019 | HILTON MEMPHIS

IMPORTANT. Please answer all the questions:

MEDICAL DEGREE:m MD m DO m PhDm List other: ____________________________

PRIMARY SPECIALTY CERTIFICATION:m Anesthesiology m Physiatrym Neurosurgery m Other: _______________________________

PAIN MEDICINE SUBSPECIALTY CERTIFICATION:m American Board of Anesthesiologym American Board of Interventional Pain Physiciansm Fellow of Interventional Pain Practicem American Board of Pain Medicinem Competency in Regenerative Medicinem Competency in Interventional Pain Managementm Other: ______________________________________

FELLOWSHIP TRAINING: mPain Medicine m Spine Surgery m Sports Medicinem Other: ______________________________________

SPECIALTY DESIGNATION:m 09 - Interventional Pain Managementm 72 - Pain Managementm Other: ______________________________________

WHAT IS YOUR PRACTICE LOCATION:m ASC m HOPD m Office-setting

PERCENTAGE OF INTERVENTIONAL PAIN MANAGEMENT PRACTICE:m 0% m 1-25% m 26-50% m 51-75% m > 75%

YEARS IN INTERVENTIONAL PAIN MANAGEMENT PRACTICE:m 0 m 1-5 m 6-10 m > 10

NUMBER OF YEARS EXPERIENCE IN REGENERATIVE MEDICINE:m 0 m 1-5 m 6-10 m > 10

TOTAL INDICATE THE NUMBER OF PROCEDURES PERFORMED DURING PAST YEAR:

PROCEDURE TOTAL PERFORMED

Caudal Epidural Injections * ____________

Lumbar Interlaminar Epidural Injections * ____________

Lumbar/Sacral Facet Joint Nerve Blocks * ____________

Lumbar Facet Joint Interlaminar Injections * ____________

Lumbar Facet Radiofrequency * ____________

Lumbar/Sacral Transforaminal Epidural Injections * ____________

Percutaneous Adhesiolysis * ____________

Sacroiliac Joint Injections * ____________

Lumbar Discography * ____________

Percutaneous Lumbar Discectomy * ____________

Cervical Interlaminar Epidural Injections * ____________

Cervical Facet Joint Nerve Blocks * ____________

Cervical Facet Joint Intraarticular Injections * ____________

Cervical Facet Radiofrequency * ____________

Cervical Discography * ____________

Thoracic Interlaminar Epidural Injections * ____________

Facet Joint Nerve Blocks * ____________

Thoracic Facet Intraarticular Injections * ____________

Thoracic Facet Radiofrequency * ____________

Thoracic Discography * ____________

Stellate Ganglion Blocks * ____________

Celiac Plexus Blocks * ____________

Lumbar Sympathetic Blocks * ____________

Hypogastric Plexus Blocks * ____________

Trigeminal Nerve Blocks * ____________

Vertebral Augmentation or Sacroplasty * ____________

CHOOSE YOUR CADAVER WORKSHOP LEVEL:m Itermediate

NUMBER OF ASIPP® INTERVENTIONAL TECHNIQUES COURSES YOU ATTENDED BY LEVEL:Basic m 0 m 1 m 2 m 3 m Other ____Intermediate m 0 m 1 m 2 m 3 m Other ____Advanced m 0 m 1 m 2 m 3 m Other ____

REGISTRATION PLEASE PRINT EXACTLY AS YOU WISH YOUR NAME TO APPEAR:

___________________________________________________________________________________________________NAME (FIRST) (MIDDLE INITIAL) (LAST)

_________________________________________________________________________________________ORGANIZATION

_________________________________________________________________________________________ADDRESS

_________________________________________________________________________________________CITY STATE ZIP

_________________________________________________________________________________________PHONE FAX CELL

_________________________________________________________________________________________E-MAIL

* If registering as a Resident or Fellow, please list below the name of fellowship program, university or hospital and fax or e-mail a letter from the program director verifying your status. Your application for registration cannot be processed and you will not receive the discount until ASIPP receives this letter. Fax the letter to 270-554-5394 or e-mail to crogers@asipp.org

________________________________________________________________________________________NAME OF FELLOWSHIP PROGRAM

PAYMENT METHOD (Please check one):m MASTERCARD m VISA m AMERICAN EXPRESS m DISCOVER

________________________________________________________________________________________CREDIT CARD NUMBER SECURITY CODE (Back of Card) EXP. DATE

________________________________________________________________________________________NAME ON CARD

________________________________________________________________________________________AUTHORIZED SIGNATURE (required on all credit card orders)

(Your application will not be processed if payment does not accompany registration form)

RETURN COMPLETED FORM TO:ASIPP®, 81 Lakeview Drive, Paducah, KY 42001 or Fax to 270-554-5394

CANCELLATION POLICY:ASIPP reserves the right to cancel this course upon reasonable notice and will assume no financial obligation to registrants for cancellation for reasons beyond its control. Registration fees will be refunded, however, costs incurred by the registrants, such as airline or hotel fees or penalties, are the responsibility of the registrants. ASIPP requires a 30-day notice of cancellation. Cancellations must be submitted in writing by June 12, 2019. Cancellations after June 12, 2019 but prior to June 26, 2019 will forfeit 50% of their registration fee. No refunds can be made after June 26, 2019.

REGISTER ONLINE AT http://www.asipp.org/ASIPP-National-Meetings.html

INTERVENTIONAL TECHNIQUES REVIEW COURSE AND CADAVER WORKSHOPAll registrations must be approved

REVIEW COURSE AND CADAVER WORKSHOP

m $3,500 Member m $3,800 Non-Memberm $1,900 Fellow/Resident *

CADAVER WORKSHOP LEVEL m Intermediate

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