ASIPP Educational Services Excellence in the education of Interventional Pain Physicians NEUROMODULATION

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1 ASIPP Educational Services Excellence in the education of Interventional Pain Physicians INTERVENTIONAL TECHNIQUES COMPREHENSIVE REVIEW COURSE 7.75 AMA PRA Category 1 Credits (Plus Free Online Lectures) AND CADAVER WORKSHOP 11 AMA PRA Category 1 Credits OCTOBER 5-7, 2018 MEMPHIS, TN COURSE VENUE HILTON MEMPHIS 939 Ridge Lake Boulevard, Memphis, TN TEL: FAX: CADAVER WORKSHOP VENUE MEDICAL EDUCATION & RESEARCH INSTITUTE 44 South Cleveland, Memphis, TN (901) (800) SPECIALS 50% off course fee for Resident/Fellows THIS COURSE IS OPEN TO PHYSICIANS ONLY REVIEW COURSE AND CADAVER WORKSHOP BEST PRICE AND PROGRAM IN IN AMERICA! American Society of Interventional Pain Physicians The Voice of Interventional Pain Management

2 COMPREHENSIVE REVIEW COURSE AND CADAVER WORKSHOP 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 Neuromodulation Comprehensive Review Course and Hands-On Cadaver Workshop. The 1 day didactic course is October 5 at the Memphis Hilton and the 1.5 day Cadaver Workshop is October 6-7 at the Medical Education Research Institute facility. This course meets the needs of interventionalists based on input and needs assessment. COURSE DIRECTORS Chairman of the Board and Chief Executive Officer, ASIPP EDUCATIONAL OBJECTIVES/TARGET AUDIENCE This comprehensive review course and cadaver workshop for Neuromodulation are 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 Neuromodulation Incorporate interventional techniques in treating your patients so that patients have better outcomes and reduced side effects AMERICANS WITH DISABILITIES ACT AND SPECIAL SERVICES Organizers 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) at least 10 days prior to the conference. ACCREDITATION STATEMENT This 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 CREDIT The Institute for Medical Studies designates the Interventional Techniques Comprehensive Review Course live activity for a maximum of 7.75 AMA PRA Category 1 Credits and the Interventional Techniques Comprehensive Cadaver Workshop live activity for a maximum of 11 AMA PRA Category 1 Credits. Physicians should only claim 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. ACCOMMODATIONS HILTON MEMPHIS 939 Ridge Lake Boulevard Memphis, TN TEL: FAX: Enjoy rooms with luxurious bedding, 49-inch flat-screen TVs, WiFi and large work desks. A true gem among hotels in Memphis, TN, the Hilton Memphis hotel is in the heart of the East Memphis business district, a short distance from top attractions. This hotel is located just a few miles from the upscale shops, cinemas and restaurants on Poplar Avenue. Downtown Memphis is just a 20-minute drive and the airport is just 15 minutes away. In order to make your hotel reservation is with the ASIPP room block rate let the hotel know you are with the ASIPP Meeting. Hans Hansen, MD President, ASIPP Sudhir A. Diwan, MD President-Elect, ASIPP Director Emeritus, ASIPP FACULTY Alaa Abd-Elsayed, MD Madison, WI Bloomington, IL Richard Weiner, MD Temecula, CA George Arcos, DO Jupiter, FL Bloomington, IL Harold Cordner, MD Sebastian, FL Sudhir Diwan, MD New York, NY Hans Hansen, MD Conover, NC Paducah, KY Ramarao Pasupuleti, MD Bowling Green, KY AJ Rastogi, MD Hainesport, NJ Amol Soin, MD Dayton, OH Ricardo Vallejo, MD Bloomington, IL Bradley Wargo, DO Collierville, TN Art Watanabe, MD Bellingham, WA Richard Weiner, MD Temecula, CA 2 American Society of Interventional Pain Physicians

3 COMPREHENSIVE REVIEW COURSE AND CADAVER WORKSHOP FRIDAY, OCTOBER 5, 2018 COMPREHENSIVE REVIEW COURSE FOR INTERVENTIONAL TECHNIQUES 6:30 am 7:55 am REGISTRATION AND BREAKFAST 7:55 am 10:00 am Session Chair Hans Hansen, MD 7:55 am 8:15 am Introduction to Workshop and ASIPP - Hans Hansen, MD 8:15 am 8:30 am Fluoroscopic Safety - Art Watanabe, MD 8:30 am 9:15 am Lumbar Epidural Injections and Adhesiolysis: Caudal, Interlaminar, Transforaminal 9:15 am 9:30 am Sacroiliac Joint Injections and Radiofrequency Thermoneurolysis - Hans Hansen, MD 9:30 am 10:25 am BREAK WITH EXHIBITORS 10:25 am 12:00 am Session Chair Hans Hansen, MD 10:25 am 10:30 am Introduction by Session Chair - Hans Hansen, MD 10:30 am 10:45 am Lumbar Facet Joint Interventions (Intraarticular Injections, Nerve Blocks and Radiofrequency Thermoneurolysis) - 10:45 am 11:00 am Cervical Facet Joint Interventions (Intraarticular Injections, Nerve Blocks and Radiofrequency Thermoneurolysis - Hans Hansen, MD 11:00 am 11:15 am Thoracic Facet Joint Interventions (Intraarticular Injections, Nerve Blocks and Radiofrequency Thermoneurolysis): Anatomy and Technical Considerations 11:15 am 11:40 am Head and Neck Blocks (Trigeminal and Stellate) - Alaa Abd-Elsayed, MD 11:40 am 12:00 pm Cervical and Thoracic Interlaminar Epidural Injections - 12: 00 pm 12:55 pm LUNCH Interfacing Evidence-Based Medicine, Guidelines, and Regulations with Clinical Practice 12:55 pm 3:00 pm Session Chair- Amol Soin, MD 12:55 pm 1:00 pm Introduction by Session Chair - Amol Soin, MD 1:00 pm 1:20 pm Celiac Plexus and Lumbar Sympathetic Blocks (Anatomy and Technical Considerations) Alaa Abd-Elsayed, MD 1:20 pm 1:40 pm Knee and Hip Injections and Radiofrequency Neurotomy - TBA 1:40 pm 2:20 pm Spinal Cord Stimulation: Trial and Implantation- Ricardo Vallejo, MD 2:20 pm 2:40 pm Transforaminal/Transgrade Spinal Cord Stimulation - Richard Weiner, MD 2:40 pm 3:00 pm Intrathecal Infusion Systems -Trial and Patient Selection - Amol Soin, MD 3:00 pm 3:30 pm BREAK WITH EXHIBITORS 3:30 pm 5:30 pm Session Chair - 3:30 pm 4:00 pm Peripheral Nerve Stimulation Trial and Implant - Richard Weiner, MD 4:00 pm 4:30 pm Implantation of Intrathecal Infusion Systems - Amol Soin, MD 4:30 pm 5:00 pm Lumbar Discography and Percutaneous Disc Decompression: Anatomy and Technical Considerations - Ramarao Pasupuleti, MD 5:30 pm 7:00 pm EXHIBITOR MEET & GREET American Society of Interventional Pain Physicians 3

4 COMPREHENSIVE REVIEW COURSE AND CADAVER WORKSHOP SATURDAY, OCTOBER 6, 2018 CADAVER WORKSHOP FOR SHUTTLE TO CADAVER WORKSHOP FACILITY REGISTRATION AND BREAKFAST 8:00 am 8:45 am Overview of Cadaver Workshop - 9:00 am 12:00 pm HANDS-ON CADAVER WORKSHOP 12:00 pm 1:00 pm LUNCH 1:00 pm 5:00 pm HANDS-ON CADAVER WORKSHOP SHUTTLE TO HOTEL SUNDAY, OCTOBER 7, 2018 CADAVER WORKSHOP FOR SHUTTLE TO CADAVER WORKSHOP FACILITY REGISTRATION AND BREAKFAST 9:00 am 12:00 pm HANDS-ON CADAVER WORKSHOP SHUTTLE TO HOTEL CADAVER WORKSHOP PROCEDURES 1. Trial lead placement for low back pain 2. Trial lead placement for neck pain 3. Spinal cord stimulator permanent implant placement (conventional) 4. Wireless trial and permanent placement 5. Transforaminal trial and permanent placement 6. Placement of intrathecal infusion system 7. Intercostal nerve stimulation 8. Sacroiliac stimulation 9. Suprascapular nerve stimulation 10. Free forum 4 American Society of Interventional Pain Physicians

5 COMPREHENSIVE REVIEW COURSE AND CADAVER WORKSHOP REGISTRATION REGISTRANT INFORMATION IMPORTANT. Please answer all the questions: MEDICAL DEGREE: m MD m DO m PhD m List other: PRIMARY SPECIALTY CERTIFICATION: m Anesthesiology m Physiatry m Neurosurgery m Other: PLEASE PRINT EXACTLY AS YOU WISH YOUR NAME TO APPEAR: NAME (FIRST) (MIDDLE INITIAL) (LAST) ORGANIZATION ADDRESS PAIN MEDICINE SUBSPECIALTY CERTIFICATION: m ABMS Pain Medicine (Anesthesiology, PMR, Neurology, Psychiatry, Emergency Medicine) m American Board of Pain Medicine m American Board of Interventional Pain Physicians m Fellow of Interventional Pain Practice (FIPP) FELLOWSHIP TRAINING: m Pain Medicine m Spine Surgery m Sports Medicine m Other: SPECIALTY DESIGNATION: m 09 - Interventional Pain Management m 72 - Pain Management m Other: CITY STATE ZIP PHONE FAX REVIEW COURSE AND CADAVER WORKSHOP All registrations must be approved 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% 1 DAY REVIEW COURSE AND 1.5 DAY CADAVER WORKSHOP m $4,650 Member m $4,950 Non-Member YEARS IN INTERVENTIONAL PAIN MANAGEMENT PRACTICE: m 0 m 1-5 m 6-10 m > 10 TOTAL NUMBER OF PROCEDURES PERFORMED DURING PAST YEAR: PROCEDURE 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 Automated 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 TOTAL PERFORMED 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 or Fax to 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 September 6, Cancellations after September 6, 2018 but prior to September 21, 2018 will forfeit 50% of their registration fee. No refunds can be made after September 21, REGISTER ONLINE AT American Society of Interventional Pain Physicians 5

6 American Society of Interventional Pain Physicians 81 Lakeview Drive, Paducah, KY COMPREHENSIVE REVIEW COURSE 7.75 AMA PRA Category 1 Credits (Plus Free Online Lectures) AND CADAVER WORKSHOP 11 AMA PRA Category 1 Credits OCTOBER 5-7, 2018 MEMPHIS, TN COURSE VENUE HILTON MEMPHIS 939 Ridge Lake Boulevard, Memphis, TN TEL: FAX: CADAVER WORKSHOP VENUE MEDICAL EDUCATION & RESEARCH INSTITUTE 44 South Cleveland, Memphis, TN (901) (800) SPECIALS Special room rates through September 13, % off course fee for Resident/Fellows THIS COURSE IS OPEN TO PHYSICIANS ONLY PRSRT STD U.S. POSTAGE PAID PADUCAH, KY PERMIT #44