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IGNITE. INSPIRE. INNOVATE. TAKING PALLIATIVE CARE TO THE NEXT LEVEL 8TH ANNUAL SUMMIT MAY 12-13, 2016 NEWPORT BEACH, CA CCCCSUMMIT.ORG

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Page 1: IGNITE. INSPIRE. INNOVATE. - ccccsummit.org · MAY 12-13, 2016 NEWPORT BEACH, CALIFORNIA CCCCSUMMIT.ORG IGNITE. INSPIRE. INNOVATE. TAKING PALLIATIVE CARE TO THE NEXT LEVEL AUDIENCE

IGNITE.INSPIRE.

INNOVATE.TA K I N G P A L L I AT I V E C A R E

T O T H E N E X T L E V E L

8TH ANNUAL SUMMITMAY 12-13, 2016

NEWPORT BEACH, CACCCCSUMMIT.ORG

Page 2: IGNITE. INSPIRE. INNOVATE. - ccccsummit.org · MAY 12-13, 2016 NEWPORT BEACH, CALIFORNIA CCCCSUMMIT.ORG IGNITE. INSPIRE. INNOVATE. TAKING PALLIATIVE CARE TO THE NEXT LEVEL AUDIENCE

2 Share your inspiration: #cccc16 IGNITE . INSPIRE . INNOVATE .

Join us as we listen to, learn from, and engage with inspiring innovators and thought leaders who are taking palliative care to the next level.

COURSE OBJECTIVES

Following the Summit, healthcare professionals will be able to:• Understand the role technology can

play in end-of-life care, and discuss guiding principles of technology and end-of-life care

• Articulate three examples of unethical communication and employ the major principles of ethical communication

• Identify the five biggest blocks to ethical communication

• Describe the provisions of the End-of-Life Option Act and its relationship to advance care planning

• Explore possible implications of physician “aid-in-dying” for advance care planning conversations and begin to develop recommendations, guidelines or best practices for incorporating this content in advance care planning conversations

• Describe ways that families, patients and doctors can misunderstand each other’s language

• Recognize three often-used medical words or phrases, intended to address prognosis and goals of care, that families may interpret as confusing or abandoning

• Describe the disconnect between the hopes created by World War II era medical advances and the conditions faced by older patients today

Two Days of Education & Inspiration in Palliative Care

MAY 12-13, 2016NEWPORT BEACH, CALIFORNIA

CCCCSUMMIT.ORG

IGNITE.INSPIRE.INNOVATE.TA K I N G P A L L I AT I V E C A R E T O T H E N E X T L E V E L

AUDIENCE

Now in its 8th year, the Coalition for Compassionate Care of Califor-nia Annual Summit is designed for physicians, nurses, social workers, nursing home administrators, chap-lains, patients and others interested in clinical research, quality and policy as it pertains to palliative care.

DISCOVER best practices for creating meaningful and engaging patient experiences to improve care for all who are seriously ill or nearing the end of life.

IMMERSE yourself in two days full of talks, breakouts, office hours and social events.

MEET thought leaders and palliative care innovators from around the country.

The Coalition for Compassionate Care of California promotes high-quality, compassionate care for all who are seriously ill or nearing the end of life. Our goal is to transform healthcare so that medical care is aligned with individual patient preferences—that people get the care they need and no less, and the care they want and no more.

8TH ANNUAL SUMMIT

Page 3: IGNITE. INSPIRE. INNOVATE. - ccccsummit.org · MAY 12-13, 2016 NEWPORT BEACH, CALIFORNIA CCCCSUMMIT.ORG IGNITE. INSPIRE. INNOVATE. TAKING PALLIATIVE CARE TO THE NEXT LEVEL AUDIENCE

Register online: ccccsummit.org/registration 3T A K I N G P A L L I A T I V E C A R E T O T H E N E X T L E V E L

Thursday, May 12, 2016

8:00 – 4:45 p.m.Exhibits Open

8:00 – 8:30 a.m.Registration & Breakfast

8:30 – 8:45 a.m. Welcome

8:45 – 10:00 a.m. Keynote

10:15 – 11:30 a.m.Breakout Sessions

11:30 a.m. – 12:15 p.m.Networking Lunch

12:15 – 2:30 p.m.General Session

2:45 – 3:30 p.m.Office Hours

3:45 – 4:45 p.m.General Session

4:45 – 6:00 p.m.Reception & Poster Session

Friday, May 13, 2016

8:00 – 4:00 p.m.Exhibits Open

8:00 – 8:30 a.m.Registration & Breakfast

8:30 – 9:15 a.m.General Session

9:15 – 10:15 a.m.Keynote

10:30 – 11:30 a.m.General Session

11:30 – 12:15 p.m.Office Hours

12:15 – 1:30 p.m.Lunch & Leadership Awards

1:30 – 2:45 p.m.Breakout Sessions

2:45 – 3:00 p.m.Entertainment

3:00 – 4:00 p.m.General Session

4:00 – 4:15 p.m.Closing

California HealthCare Foundation

John and Wauna Harman Foundation

Sharp HospiceCare

CSU Institute for Palliative Care

Kindred Healthcare

LightBridge Hospice & Palliative Care

LeadingAge California

SCAN Health Plan

Transcend Translations

CALTCM

NEW IN 2016

Pediatric TrackA special pediatric palliative care track is running through-out the Summit. Organized by the Children’s Hospice & Palliative Care Coalition, the pediatric track features education and office hours specific to healthcare professionals who work with children, adolescent and young adult patients. Look for the purple kite in this program to find all pediatric education opportunities!

Thursday, May 12• Blending Alternative Pain

& Symptom Management with Traditional Pediatric Palliative Care

• Building Confidence Levels for Adult-Trained Nurses Caring for Children

Friday, May 13• The Family Perspective:

Interactive Q&A with adolescents living with a life-threatening condi-tion and their caregiving parents

• Cultivating Resilience & Combating Compassion Fatigue in Pediatric Providers

The Children’s Hospice & Palliative Care Coalition, a division of the Coalition for Compassionate Care of California, is dedicated to im-proving children’s access to community-based palliative and hospice care services through advocacy, program development and education.

SCHEDULE AT-A-GLANCE

THANK YOU TO THE SUMMIT SPONSORS

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4 Share your inspiration: #cccc16 IGNITE . INSPIRE . INNOVATE .

KEYNOTE

Let Patients Help: How doctors, nurses, patients and caregivers can partner for better caree-Patient Dave chose his slogan – “Let patients help” – carefully. It’s not that doctors are bad or health care corrupt. Rather his message is about enabling, empowering, engaging and equipping patients to play an active role in their health care. e-Patient Dave believes that rich conversations await us as patients and providers alike shift away from the pater-nalistic past and toward the shared responsibilities of participatory medicine.Dave deBronkart, also known as “e-Patient Dave,” is the author of Let Patients Help: A Patient Engagement Handbook and one of the world’s leading advocates for patient engagement. His writings have been pub-lished in the British Medical Journal, the Society for General Internal Medicine Forum, iHealthBeat, and the journal of the American Society for Clinical Oncology.

WELCOME

Setting the Stage: Making the most of these two daysJudy Thomas, JD, CEO, Coalition for Compassionate Care of California

BREAKOUT SESSIONS

What Gives Your Life Meaning: A young adult-focused palliative care campaignLearn how CSU San Marcos took up the challenge of educating its stu-dents through the “What Gives Your Life Meaning” campaign, a six-week campus-wide campaign designed to increase students’ knowledge of palliative care and advance care planning. Presenters will also outline the steps to engage emerging adults in discussions about end-of-life care.Sharon Hamill, Veronica Anover, Rocio Guillen-Castrillo, Colleen Moss, Catherine Matsumoto, Caroline Boaz and Eileen Pier-sa, California State University San Marcos

Delivering Palliative Care Across the Continuum: A patient-focused healthcare system’s storyHear how MemorialCare Health System in Southern California is transforming its palliative care services. The program now offers services across the entire continuum of care, including a palliative care at-home program serving patients of south Orange County. MemorialCare looked at other successful programs in the region and then worked to educate all levels of the organiza-tion, from direct practitioners in the hospital to medical offices in the community. Lorellen Green, MD, MemorialCare Medical Group; Louise Della Bella and Oswald Jau-wena, NP, Saddleback Memorial Medical Center

DASH: Innovative urgent care services at homeIn California as well as nationwide, statistics reveal that seniors often use hospital emergency rooms (ER) for what is considered routine or urgent care. Doctors Assisting Seniors at Home (DASH), a program funded by the Affordable Care Act, has

decreased ER visits by an astounding 40% among the older adults it serves! Learn how the DASH program has made a dramatic improvement in the lives of seniors, often avoiding a health crisis, by facilitating better care and better health.Jeanne West, RN, MHA, Doctors Assisting Seniors at Home (DASH)

Are You Being Served? Addressing the medically under-served in our communityFrequently, our western-based ap-proach to healthcare delivery is “one-size fits all.” We will explore how we can expand access to quality end-of-life care to the medically under-served, culturally diverse populations with specially tailored messaging. It begins with information on advance care planning and patient/family goals of care in a culturally sensitive and linguistically accurate manner. This makes it possible to move for-ward with aligning treatment plans with patient and family expectations for care.Michael Demoratz, PhD, LCSW, CCM, Supportive Care Services Foundation

SESSIONS | Thursday, May 12, 2016

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Register online: ccccsummit.org/registration 5T A K I N G P A L L I A T I V E C A R E T O T H E N E X T L E V E L

Effective Integration of Spirituality in Palliative CareWe are becoming increasingly aware of the important role spirituality can play in the well-being of older adults. This workshop will provide a view of spirituality that can be used by all practitioners with all patients – re-ligious or non-religious, cognitively aware or challenged, as well as adherents of all faith traditions. Pre-senters will explore the potential for spiritual growth that can come with aging and coping with serious illness, and will challenge participants to rethink their own views about spiritu-ality and older adulthood.Stephen Peterson, MDiv, Seasons Hospice & Palliative Care of Los Angeles; Donald Koep-ke, MDiv, BCC, California Lutheran Homes; Cordula Dick-Muehlke, PhD, Cordula Cares

Deconstructing Diversity Explore key issues related to diversity that impact the provision of care in, and management of, long-term care facilities. Recognizing that diversity can include many factors, such as race, ethnicity, sexual orientation,

gender identity, religion, and more, this interactive session will offer recommendations to improve the management of staff and improve the care of residents in this changing culture.Tim Vincent, MS, California Prevention Train-ing Center

Blending Alternative Pain & Symptom Management with Traditional Pediatric Palliative Care This workshop will examine recent clinical data and family testaments regarding the use of various alterna-tive treatments including CBD/THC blends and their increasing potential in pediatric palliative care. It will also explore the pharmaceutical and legal issues related to accessing these medications. David Sine, MD, Valley Children’s Hospital, Tulare Pediatric Hospice, and Hinds Hospice Pediatric Program

GENERAL SESSIONS

The State of Serious Illness Care in CaliforniaA look at the current status of pallia-tive care and advance care planning in California and CCCC’s 10-year vision for creating the future we all want.Judy Thomas, JD, CEO, Coalition for Compassionate Care of California

Payer-Provider Experiences: Challenges in providing access to community-based palliative carePayers and providers are figuring out how to create the best model to provide access to quality communi-ty-based palliative care. In this panel you will learn about initiatives to bring palliative care to both Medi-Cal (through SB 1004) and commercial-ly-insured patientsRobert Moore, MD, MPH, Partnership Health Plan; Linda Gibson, Collabria Care (formerly Napa Valley Hospice & Adult Day Services); Torrie Fields, MPH, Blue Shield of California; A representative of Hospice By The Bay; Brook Calton, MD, MHS, University of Cali-fornia, San Francisco (invited)

SESSIONS | Thursday, May 12, 2016

GENERAL SESSION

Technology & Advance Care Planning: A scalable catalyst for changeTechnology has played a role in revolutions and social movements throughout the U.S. and around the world. Within this context, Dr. Davis will explore the role of technology in medical decision making and end-of-life care, discussing guiding principles, building blocks, outreach to different constituencies and barriers we’ll face in the years to come. Aretha Delight Davis, MD, JD is co-founder and executive director of ACP Decisions, a non-profit foundation whose goal is to empower patients and families with knowledge. Prior to her medical career, Dr. Davis was a practicing attorney who advocated on behalf of Medicaid recipients and the uninsured and has had a long-standing interest in applying her legal skills for vulnerable populations to promote more patient-cen-tered care. She received her undergraduate degree from Harvard, a law degree from the University of Pennsylvania, and a medical degree from Harvard.

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6 Share your inspiration: #cccc16 IGNITE . INSPIRE . INNOVATE .

GENERAL SESSIONS

How Palliative Care Fits into Trends in Health CarePalliative care increases patient and family satisfaction, improves quality of life and has been shown to extend survival. Dr. Hernandez will discuss how expanded access to palliative care fits into the new and highly com-petitive healthcare market.Sandra Hernández, MD, President & CEO, California HealthCare Foundation

ACP Under PAD: How physician aid-in-dying will change our conversationsRegardless of one’s ethical views on physician aid-in-dying (PAD), its avail-ability as an option may affect many advance care planning (ACP) conver-sations. Now that PAD is a reality in California, healthcare professionals, and physicians in particular, may find themselves faced with questions

with which they are not familiar or comfortable answering. What infor-mation do we as ACP facilitators and experts need to have in order to an-swer questions, explore requests, and refer patients to appropriate resourc-es? How can we manage personal viewpoints and ethical commitments that may clash with those of patients seeking our advice? Jennifer Ballentine, MA, Vice President, Hospital Analytics; Nathan Fairman, MD, MPH, Assistant Health Sciences Clinical Pro-fessor, UC Davis Department of Psychiatry; Karl Steinberg, MD, CMD, Stone Mountain Medical Associates, Inc.

BREAKOUT SESSIONS

Implementing Community-Based Palliative Care in a Managed Care EnvironmentLightBridge and Health Net have worked together to develop a com-munity-based palliative care pro-gram for Health Net’s most clinically complex members. Hear how com-

munity-based palliative care is being provided to a select group of Health Net’s sickest, most expensive and often most marginalized members liv-ing in the San Diego region. Present-ers will discuss contract development, patient identification, tracking of met-rics and the operational approach required to achieve successful com-munication and program operations within the managed care provider relationship.Jill Mendlen, LightBridge Hospice; Marvin Gordon, Health Net of California

Palliative Care Starts in the Emergency RoomDr. Wang will demonstrate the value of emergency medicine as a cor-nerstone of comprehensive palliative care. He will highlight three key areas: benefits from direct and early emergency department (ED) referral to palliative care; a pilot project at a large academic center which tripled

SESSIONS | Friday, May 13, 2016

KEYNOTE The Dream of a Common Language: A shared reality for patients and medical teamsPalliative care is only starting to develop a common language, understandable by patients and families, to express the changing realities of illness and death in an era of high-tech medicine. Doctors hoping to facilitate shared medical decision making may unwittingly use terms that families find frightening, abandoning or mystifying. In this personal retell-ing of her parents’ desires for “good deaths” and their conflicts with their doctors, author and former family caregiver Katy Butler will help you develop and refine a poetic, honest, “kitchen table language” to better serve and understand patients.Katy Butler is an award-winning journalist and author who has written about end-of-life medicine, neurosci-ence and human behavior for the New Yorker, The New York Times, JAMA-Internal Medicine, Best American Essays, Best Buddhist Writing, and other leading publications. Her bestselling book, Knocking on Heaven’s Door: The Path to a Better Way of Death, a memoir of shepherding her parents through their final declines, was named “One of the 100 Notable Books of the Year (2013)” by The New York Times. An inspiring public speaker, investigative journalist and former family caregiver, she is passionate about improving end-of-life medicine and frequently gives talks on improving doctor-patient communication and creating a new “art of dying” for our high-tech age.

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Register online: ccccsummit.org/registration 7T A K I N G P A L L I A T I V E C A R E T O T H E N E X T L E V E L

ED-to-palliative care referrals over six months; and next steps and barriers to implementation for emergency departments. David Wang, MD, Stanford Healthcare

Palliative Care in Skilled NursingWhile the goal of skilled nursing care is to maintain residents’ mental and physical function, learn how many of the principles and practices of pal-liative care are compatible with this goal and can be incorporated into nursing care. These include advance care planning, pain and symptom management, attention to emotional and spiritual well-being, and support to families.Shelly R. Garone, MD, FACP, Kaiser Perma-nente, North Sacramento Valley

Building Palliative Care: Organization and people first, clinical secondWhether you are an MD, RN or administrator, if your organization is looking at palliative care or trying to

make it work, join this session for a guided tour of what it takes to build a successful program. Using the Palli-ative Care Roadmap, we’ll walk you through what you need to develop your own plan for success. This session will give you the tools to build your program to maximize success … and minimize stress. Helen McNeal, CSU Institute for Palliative Care

Being Mortal: Using Being Mortal to spark com-munity advance care planningIn 2015, a documentary based on Atul Gawande’s best-seller Being Mortal aired on public television stations nationwide. Following this showing, the California HealthCare Foundation and the John and Wau-na Harman Foundation funded 39 local organizations across California to host community screenings of the documentary. Learn about this exciting project including audience reactions and connecting with un-derserved communities. Plus, find out

about holding a Being Mortal screen-ing in your community.Julie Boudreau, Healthcare Consultant; Veva Arroyo and Pauline Le, Sharp Palliative & Hospice Care

The Family Perspective: Interactive Q&A with adolescents living with a life-threatening condition and their caregiving parents In order to serve families best, we must know what is important to them. This workshop is a unique opportunity to intimately interact with a panel of adolescents living with life-threatening conditions and their caregiving parents. Participants will be able to ask questions of the panel in a safe, supportive and non-judgmental environment.

GENERAL SESSION

Musical Interlude Threshold Choir, Orange County Chapter

SESSIONS | Friday, May 13, 2016

GENERAL SESSION

Ethical Communication: What is it and how do I practice it?While many clinicians have learned the basics of communication, few have learned the Principles of Ethical Communication. Using case-studies and humor, Mr. Westbrook will show how to quickly establish trust and rapport; minimize defensive reactions; avoid pa-tient manipulation based on clinician biases; respond in, rather than react to, a situation; improve clinical outcomes and increase patient satisfaction.G. Jay Westbrook, RN, MS, CHPN is a multiple award-winning clinician, author and speaker, as well as Visiting Faculty Scholar at Harvard Medical School, winner of the Pfizer Medical Humanities Initiative Award and recent recipient of the Pierre Salmon Award for Clinical Excellence in Care of the Dying. Mr. Westbrook has an MS in Gerontology, is a certified Grief Recovery Specialist, a credentialed Spiritual Counselor, a registered nurse, and a certified hospice and palliative nurse. He has worked at the bedside with the dying for a quarter century, in hospital-based palliative care, hospital-based pain management, community-based hospice and prison hospice. Mr. Westbrook is also Clinical Director of Compassionate Journey, an end-of-life clinical and education service.

Page 8: IGNITE. INSPIRE. INNOVATE. - ccccsummit.org · MAY 12-13, 2016 NEWPORT BEACH, CALIFORNIA CCCCSUMMIT.ORG IGNITE. INSPIRE. INNOVATE. TAKING PALLIATIVE CARE TO THE NEXT LEVEL AUDIENCE

8 Share your inspiration: #cccc16 IGNITE . INSPIRE . INNOVATE .

GENERAL TOPICS

• Donate Life• Using Videos as Part of ACP• Pediatric Palliative Care• Engaging Patients in ACP• Patients in Denial• Mediation Techniques• Working with Diverse Popula-

tions• Patient-centered Prognostication• National Healthcare Decisions

Day Efforts• ACP for the Homeless• Transdisciplinary Teams• Engaging Faith Leaders• Slow Medicine• Working with ACP Decisions• Emotional Fatigue

PEDIATRIC-SPECIFIC

• Building confidence levels for adult-trained nurses in caring for children

• Cultivating resilience and combating compassion fatigue in pediatric providers

FACILITATORS INCLUDE...

• Julie Boudreau• Kim Bower, MD• Katy Butler• Teri Collet, ACSW, LCSW, ACHP-SW• Delia Cortez, LCSW• “e-Patient” Dave deBronkart• Aretha Delight Davis, MD, JD• Linda Healy• Daniel Hoefer, MD• Jaclyn Manzanedo, CTBS• John Tasted• Tim Vincent, MS• G. Jay Westbrook, RN, MS, CHPN• Sandee Wishon, RN, MS, CHPN• Christine Wilson, RN, JD

Compassionate Care Leadership AwardsPRESENTED DURING LUNCH ON FRIDAY, MAY 13, 2016, 12:15 – 1:30 P.M.

Join us in celebration of the winners of the annual Compassionate Care Leadership Awards.

Poster Session & Reception THURSDAY, MAY 12, 2016, 4:30 – 6 P.M.

Join us for cocktails, hor d’oeuvres, and a poster session featuring a showcase of the best communi-ty-based palliative care programs and projects from around the state.

Submit poster proposals by Friday, February 26, 2016.

Poster topics should focus on programs and projects that increase access to community-based palliative care.

Learn more at http://ccccsummit.org.

SPECIAL FEATURES

Office HoursBRING QUESTIONS. GET ANSWERS. CONSULT WITH EXPERTS ON A VARIETY OF TOPICS.

Office Hours is an informal, small group setting allowing participants to share the latest information and best practices on a variety of topics. Take advantage of this unique opportunity to meet one-on-one with experts and get answers to your most pressing questions.

RECEPTION SPONSORED BY

Be A Sponsor!Sponsor California’s premier palliative care conference and take advantage of the opportunity to network with 400+ participants.

Demonstrate your organization’s commitment to changing the way we care for seriously-ill Californians, and join us as a sponsor today. Sponsorship levels vary. Learn more at http://cccsummit.org/sponsor.

Contact us at (916) 489-2222 or [email protected].

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Register online: ccccsummit.org/registration 9T A K I N G P A L L I A T I V E C A R E T O T H E N E X T L E V E L

Hotel RegistrationFAIRMONT NEWPORT BEACH

4500 MacArthur Boulevard Newport Beach, CA 92660

SPECIAL RATE: $159 single/double

SPECIAL RATE CUTOFF DATE:

April 20, 2016

RESERVATIONS: (949) 476-2001

HOTEL & TRAVEL

Meeting LocationThe Fairmont Newport Beach offers legendary Southern California hospitality in the finest style. Enjoy California-inspired cuisine, spa treatments, state-of-the-art fitness and business centers, a heated sky pool and Fairmont Gold facilities, only five miles from gorgeous Pacific Ocean coastline and in the heart of the area’s fastest growing business community.

TransportationAIRPORT INFORMATION

The closest airport to Fairmont Newport Beach is Orange County / John Wayne Airport (SNA). SNA caters to most major international flights, and is a five-minute drive from the Fairmont Newport Beach hotel.

AIRPORT SHUTTLE

A complimentary shuttle service runs from the airport to the hotel. Reserva-tions are not required. Call the hotel bell desk to arrange a ride to the airport.

Newport BeachBeyond the radiant sun, sand and surf, discover the sophisticated charm of Newport Beach, CA. A place so intoxicating, one taste of the perfect life will keep you coming back for more. From sunset cruises to surf lessons, wine tastings to harbor-front promenades, Newport Beach offers more things to do and more ways to relax, unwind and enjoy picturesque views. With the largest recreational harbor on the west coast, Newport Beach offers ten miles of extraordinary fishing, swimming, surfing and aquatic sports activities.

Stay for the weekend!Disneyland Park and Disney California Adventure Park are just 15 minutes from the Fairmont New-port Beach Hotel.

Extend your stay through the week-end for some fun in the sun with your friends Mickey and Minnie, and check out new attractions with the characters from Star Wars.

Page 10: IGNITE. INSPIRE. INNOVATE. - ccccsummit.org · MAY 12-13, 2016 NEWPORT BEACH, CALIFORNIA CCCCSUMMIT.ORG IGNITE. INSPIRE. INNOVATE. TAKING PALLIATIVE CARE TO THE NEXT LEVEL AUDIENCE

SUMMIT REGISTRATION

ONLINE @ http://ccccsummit.org/registrationFAX (888) 789-9475 / PHONE (916) 489-2222CCCC SUMMIT, 1331 GARDEN HIGHWAY, SUITE 100, SACRAMENTO, CA 95833MORE INFORMATION: [email protected]

NAME SUFFIX

TITLE ORGANIZATION

ADDRESS

@

EMAIL PHONE TWITTER HANDLE

CONTINUING EDUCATION

{ Physician {Nursing { Social Work {Nursing Home Administrator

{ Certificate of Completion License No. (required):

CCCC 8th ANNUAL SUMMIT REGISTRATIONRegistration includes summit materials, and continental breakfast and lunch on both days. Limited partial scholarships are available. Contact CCCC for more information at [email protected] or (916) 489-2222.

EARLY BIRD (Postmarked by March 11, 2016) { CCCC Member ...............................................................$359 { Non-Member .................................................................$449

REGULAR (Postmarked between March 12 and April 11, 2016) { CCCC Member ...............................................................$435 { Non-Member .................................................................$535

LATE BIRD (Postmarked after April 11, 2016) { CCCC Member ............................................................... $535 { Non-Member ................................................................. $635

CCCC MEMBERSHIP / I would like to become a member of CCCC { Individual .......................................................................$50

All staff of organizational members can attend at the member rate. For more information, visit CoalitionCCC.org/membership

You must have paid CCCC dues for the current year to qualify for the membership rate. To verify, contact CCCC at (916) 489-2222 or [email protected].

If registering as a member, specify membership type: { Organization { Community Coalition { Individual

Indicate the name of the organization or coalition that is a current CCCC member: _____________________________________________________

CCCC DONATION Keep up the good work!AMOUNT $___________________________________________________

TOTAL $_____________________________________________________

PAYMENT METHODAll registrations must be pre-paid:

{ Check enclosed payable to Coalition for Compassionate Care of California { Credit Card (Visa, Mastercard or Discover)

Name (as it appears on card)

Billing Address

City State Zip

- - -

Credit Card Number

Expiration Date (dd/yy) 3 or 4 digit security code

Signature

Faxed registration with signed purchase order is also accepted. Fax to (888) 789-9475.

Indicate below if you wish to receive one of the following meal choices.

{ Vegetarian { Vegan

Indicate below if you require special accommodations pursuant to the ADA:

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Register online: ccccsummit.org/registration 11T A K I N G P A L L I A T I V E C A R E T O T H E N E X T L E V E L

Summit Registration RatesPricing Deadline Member Non-MemberMarch 11, 2016 $359 $449April 11, 2016 $435 $535May 12, 2016 $535 $635

Online RegistrationPay online at http://ccccsummit.org/registration

Register by MailTo register by mail, complete the form on page 10 and mail it along with payment (credit card or check) to:

Coalition for Compassionate Care of California Attn: Keeta Scholl 1331 Garden Highway, Suite 100 Sacramento, CA 95833

ADA NeedsIf you require special accommodations pursuant to the Americans with Disabilities Act, call (916) 489-2222.

Cancellation PolicyA $25 non-refundable processing fee will be retained for each cancellation. Cancellations must be made in writing no later than five (5) business days prior to the Summit and faxed to (888) 789-9475 or emailed to [email protected]. No refunds will be made after this date. Substitutions are encouraged and can be made by calling (916) 489-2222. Cancellation of hotel reservation is the registrant’s responsibility.

Professional ScholarshipsLimited partial scholarships are available for healthcare professionals and students. For more information, and to get an application, contact us at [email protected] or (916) 489-2222.

e-Patient ScholarshipsPatients and families offer valuable insights and experi-ence, and serve as messengers and champions among non-healthcare professionals. Scholarship recipients are expected to attend the Summit in full.

Visit http://bit.ly/epatientdiscount to find the scholarship application, and learn more about the roles and respon-sibilities of e-patient delegates. The application deadline is March 10, 2016.

Continuing Education InformationFull attendance at all education sessions in their entirety is required to receive professional continuing education (CE) credit. All attendees must sign in at the conference and include their professional license number. In order to receive credit, participants must complete an online evaluation survey following the conference. CE certificates will be emailed within six weeks of completing the survey. Certificates of attendance will be available at the end of the conference. CME credits are graciously sponsored by Partnership HealthPlan of California.

Nursing Provider approval by the California Board of Registered Nursing. Provider Number CEP 15403 for 12 contact hours.

Social Work Provider approved by the California Association of Marriage and Family Therapists, Provider #91987, for 12 contact hours.

Nursing Home Administrators

An application has been made to the California Nursing Home Administration program for 12 NHAP/P credits. CCCC is an ap-proved NHAP provider (NHAP# CEP 1735).

Chaplains This program may be used for continuing education credit for chaplains certified with the Board of Chaplaincy Certification Inc.

Physicians

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Institute for Medical Quality/California Medical Association (IMQ/CMA) through the joint sponsorship of Partnership HealthPlan of California and Coalition for Compassionate Care of California. Partnership HealthPlan of California is accredited by the Association (IMQ/CMA) to provide continuing medical education for physicians. Partnership HealthPlan of California designates this live activity for a maximum of 12 AMA PRA Credit 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This credit may also be applied to the CMA Certification in Continuing Medical Education.

REGISTRATION

A CONFIRMATION EMAIL WILL BE SENT TO ALL REGISTRANTS AT LEAST ONE WEEK BEFORE THE SUMMIT.

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T O T H E N E X T L E V E L

8TH ANNUAL SUMMITMAY 12-13, 2016 | NEWPORT BEACH, CA

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1331 Garden Highway, Suite 100Sacramento, California 95833

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