Application For Continuing Acupuncture Education Course Approval

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Application For Continuing Acupuncture Education Course Approval Background The (TSBAE), by rule, requires a license holder to complete a certain number of hours of Continuing Acupuncture Education (CAE) courses, in certain categories, approved by the board in order to renew a license. The rules also describe the required content for CAE courses and requirements for CAE instructors. The rules referenced can be found at www.tmb.state.tx.us, under Board Rules, Chapter 183.20. The content of the course, program, or activity must be related to the practice of acupuncture or oriental medicine and must be related to the knowledge and/or technical skills required to practice acupuncture or be related to direct and/or indirect patient care. To assist you in determining the eligibility of the course, program, or activity, shown below is the statutory definition of acupuncture ( 205.001(2)(A) and (B) TEXAS OCCUPATIONS CODE ANNOTATED): "Acupuncture" means: (A) the nonsurgical, nonincisive insertion of an acupuncture needle and the application of moxibustion to specific areas of the human body as a primary mode of therapy to treat and mitigate a human condition, including evaluation and assessment of the condition; and (B) the administration of thermal or electrical treatments or the recommendation of dietary guidelines, energy flow exercise, or dietary or herbal supplements in conjunction with the treatment described by Paragraph (A). Procedure The Education Committee of the TSBAE must approve all courses. Once approved, the course is valid for a maximum of three years. Course approval may be reconsidered by the Board at any time during the three years. Retroactive approval will not be granted. A course is an organized presentation of information for the purpose of providing instruction or training in the practice of acupuncture. A program is an organized event made up of two or more courses. If you develop a program that includes only courses that have previously been approved, and the course approval is still in effect, there is no need to resubmit an application for approval of the courses in the new program format. Providers seeking approval must: complete and submit, for each course: o an Application For Continuing Acupuncture Education Course Approval form, signed by the provider s President, Chief Executive Officer, or Chief Operating Officer o a Course Information Sheet o a Course Schedule Sheet o a Course Instructor Information Sheet for each instructor of the course o participant evaluations if the course has been approved by any other state o a check in the amount of $25.00 for each course included in the submission A sample of a completed Course Schedule Sheet is included in this packet for your reference. Applications must be typewritten, and credit hours must be broken down by the hour on Course Schedule Sheet. Please refer to rule 183.20(n)(8) regarding participant evaluations. A template evaluation is included in this packet. Applications must be processed by staff and found to be in order at least 30 days prior to the next board meeting to be considered at that meeting. The forms in this packet must be used.

Application for Continuing Acupuncture Education Course Approval P.O. Box 2018 Austin, TX 78768-2018 _ Provider Name Provider Address (Street, City, State, Zip) Telephone Number E-Mail Address I, _, hereby certify that: (1) the content of the course, program, or activity is related to the practice of acupuncture or oriental medicine, and shall: (A) be related t the knowledge and/or technical skills required to practice acupuncture; or (B) be related to direct and/or indirect patient care. (2) the method of instruction is adequate to teach the content of the course, program or activity; (3) the credentials of the instructor(s) indicate competency and sufficient training, education and experience to teach the specific course, program, or activity; (4) the continuing education provider will maintain an accurate attendance/participation record on individuals completing the course, program, or activity; (5) each credit hour for the course, program, or activity is equal to no less than 50 minutes of actual instruction or training; (6) the course, program, or activity is provided by a knowledgeable health care provider or by a reputable school, state, or professional organization; (7) the course description provides adequate information so that each participant understands the basis for the program and the goals and objectives to be met; and, (8) the education provider obtains written evaluations at the end of each program, collates the evaluations in a statistical summary, and makes the summary available to the board upon request. I further certify that I am familiar with Section 183.20 of the Board Rules as they relate to Continuing Acupuncture Education. Date Signature Name Title Must be signed by the provider s President, Chief Executive Officer, or Chief Operating Officer.

Course Information Sheet Course Name: Course Description: 1. Has this course been previously approved by the in a format identical to this submission (circle one)? Yes No If yes, when was the most recent approval granted? 2. Has this course been previously approved by another state board with a formal approval process (circle one)? Yes No If yes, please attach documentation of the approval including the approval date. 3. Method of Course Instruction (circle all that apply): Lecture Distance Learning For Distance Learning Describe the format of the course: (Is it live/real-time lecture? Replay of live lecture? Reading only? ) For Distance Learning Courses that are Reading Only How long does it take the average student to complete the course? 4. Language of Instruction (please note that the language of course instruction should be included in any advertisement of the course): 5. Total number of hours* requested for this course, by continuing acupuncture education type: General Acupuncture: Practice Enhancement/Business Administration: Herbal: Ethics: Biomedicine: *One credit hour equals 50 minutes of instruction. Note: Time taken for simultaneous translation cannot be included in the hours requested for approved CAE.

Course Schedule Sheet Course Name: Instructor Name: Must be typewritten. To ensure proper consideration, please indicate the start and end times, a detailed explanation of the topic(s) covered in that hour, the CAE type and the course content type. Definitions of the CAE types are shown on the next page, as well as full content descriptions and examples of courses of each type. One credit hour is equal to 50 minutes of instruction. Describe each credit hour (or portion of a credit hour) in a separate row. CAE Type Codes: G = General Acupuncture P = Practice Enhancement H = Herbal E = Ethics B = Biomedicine Course Content Type Codes: T= Theoretical PA = Practical Application WM= Western Medicine PC = Direct/Indirect Patient Care BP= Business Practice O = Other (Explain how content relates to the practice Credit Hours Detailed Explanation of Topic(s) to be Covered of Acupuncture/Oriental Medicine) CAE Type (circle one) Course Content Type (circle all that apply) Provider: _ Please make copies as needed. Page of

Course Content Types Theoretical (T) Theoretical content related to the knowledge of acupuncture, oriental medicine or medical ethics. Examples: Meridian Theory, Yin Yang, Zang Fu Organs, Five Elements, Eight Principles, Etiology, Body Fluids, Qi, Blood, Shen, Jing, Treatment Principles and Classics, Oriental Philosophy, Diagnosis, Case Studies, Medical Ethics, Risk Management. Practical Application (PA) The application of knowledge relating to the practice of acupuncture and oriental medicine. Examples: Acupuncture Technique, Point Location, Drugless Substances, Nutrition, Exercise, Oriental Massage, Acupressure, Moxibustion, Breathing Techniques. Western Medicine (WM) Content related to Western Medicine. Examples: Courses in first aid, emergency conditions, indications for referral, understanding of diagnostic testing analysis. Direct and/or indirect patient care (PC) Content related to direct and/or indirect patient care. Examples: Sterilization and Preventive Practices, Patient Counseling, Patient Education. Business Practice (BP) Content related to business practice or medical ethics. Examples: Acupuncture Law, Medical Ethics, Patient Management, Office Management, Risk Management. Other (O) Please provide a detailed explanation in the space provided of how the course is related to the practice of Acupuncture and/or Oriental medicine. Content Not Related to the Practice of Acupuncture/Oriental Medicine No credit will be allowed for these types of courses. Examples: Courses which focus upon the practitioner s self-improvement or self-therapy, personal growth, self-awareness etc.; liberal arts courses in music, art, philosophy, and others unrelated to acupuncture or oriental medicine; all other courses not related to the practice of Acupuncture and/or Oriental Medicine.

Course Instructor Information Sheet Course Name: Instructor Name: Instructor s State Licenses Held (include type of license and license number): Instructor s Education (name and location of school, date of graduation, type of degree or major emphasis of study): Summary of Instructor s Qualifications:

Participant Evaluation Form P.O. Box 2018 Austin, TX 78768-2018 CAE Provider Name Date(s) of Program or Course Program/Course Title Instructor Name Participant s Name and License Number Date of Evaluation Did this course meet its stated objectives? Yes No Did the instructor demonstrate adequate knowledge of the course subject? Yes No Did the instructor utilize appropriate teaching methods? Yes No Do you feel that you will be able to apply what you have learned today to your practice? Yes No Would you recommend this course to other licensed acupuncturists? Yes No Additional Comments: If you have a complaint about this course, you may contact the Texas State Board of Acupuncture Examiners at the address shown above.

Course Schedule Sheet Course Name: The Clinical Application of Natural Antiviral Medications used in Traditional and Modern Chinese Medicine for the Treatment of Viral Diseases and the Enhancement of Viral Immunity Instructor Name: John Smith, L. Ac. To ensure proper consideration, please indicate the start and end times, a detailed explanation of the topic(s) covered in that hour, the CAE type and the course content type. Definitions of the CAE types are shown on the next page, as well as full content descriptions and examples of courses of each type. One credit hour is equal to 50 minutes of instruction. Describe each credit hour (or portion of a credit hour) in a separate row. Course Content Type Codes: T= Theoretical PA = Practical Application WM= Western Medicine PC = Direct/Indirect Patient Care BP= Business Practice O = Other (Explain how content relates to the practice of Acupuncture/Oriental Medicine) Credit Hours Detailed Explanation of Topic(s) to be Covered 1 Introduction to the subject of viruses and their treatment with Chinese medicine. Review of clinical virology and Immunology. 1 Chinese medicine theory of infectious disease and therapeutic strategies for the treatment of viral illnesses. 1 Same as above. 1 Review of individual herbs, formulas, and intravenous and injectable herbal medications for the treatment of viral diseases. 1 Clinical application and modification of herbal formulas, and discussion on the usefulness of acupuncture for viral conditions. 1 Summary, and question and answer session. CAE Type (circle one) Course Content Type (Circle all that apply) Provider: Acupuncture Education Associates, Inc. Page 1 of 1 Please make copies as needed.