AACS Application
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AACS Application AACS Application Document Transcript

  • AACS Application • Membership recognition pins for long-term membership • Professional liability insurance program • Listing on AACS website’s surgeon finder (includes AACSABOUT AACS Fellow and Associate members only)The American Academy of Cosmetic Surgery is a • Annual reportprofessional medical society whose members are dedicatedto patient safety and physician education in cosmetic surgery. • Online buyer’s guide with downloadable desktop searchWe are the leading representative of cosmetic surgeons from • E-mails from AACS that keep you up-to-date on AACSa diverse group of original medical specialties including: happenings and industry trends.dermatology, otolaryngology, oral and maxillofacial surgery, • Political influence as a section of a large and well respectedobstetrics and gynecology, ophthalmology and plastic and parent group that will help protect and promote thereconstructive surgery. specialty surgeon’s ability to practice • An affiliation with the American Academy of CosmeticBecoming a member of the AACS means joining a network Surgery, the only organization which openly supports allof cosmetic surgery professionals who share similar goals to disciplines and specialties of cosmetic surgeryimprove their practice, continue to expand their knowledgeand skills and promote themselves in their community andto patients. As a member you’ll also receive outstanding BENEFITS OF AACS FELLOW MEMBERSHIP ONLYbenefits such as AACS publications including the quarterly All of the above plus:American Journal of Cosmetic Surgery, discounts onAcademy sponsored meetings, the live Surgery Workshop • Complete website listing and profile, including websiteSeries and much more. link from Academy’s site • Use of Academy logoBENEFITS OF MEMBERSHIP • Complimentary media consultIn addition to public and legislative representation • Press release following admission to the Academy forto patients, media, governmental agencies, medical hometown newspaperorganizations and the entire healthcare community, AACS is • Committee assignments, leadership opportunitiespleased to offer its members the following benefits. and voting privileges• Certificate of membership• CME credit and discounted fees for all Academy- sponsored educational offerings• Subscription to the American Journal of Cosmetic Surgery (AJCS) (includes AACS Fellow, Associate, Affiliate, International, Resident and ASlSS members only)• Membership Directory listing and complimentary copy• Subscription to SURGE, a quarterly member newsletter that AACS is currently accepting applications for its features in-depth cosmetic surgery articles and AACS events January Application Review. All applications must be completed and required documents• Reduced price for Academy products and services submitted by December 5, 2008• New member listing in SURGE (following admission to the Academy) American Academy of Cosmetic Surgery | 737 N. Michigan Ave Suite 2100 | Chicago, IL 60611-5405 USA Phone 312.981.6760 Fax 312.981.6787 | E-mail membership@cosmeticsurgery.org | Website: www.cosmeticsurgery.org
  • Categories Of MembershipFELLOWFellow membership may be granted to any physician (MD or DO) who is a resident of the United States or Canada, who meetsthe following criteria: • Has performed at least one hundred (100) cosmetic surgery procedures as the independent surgeon during a two-year period prior to applying for membership. • Can show evidence that they are scheduling cosmetic surgery patients in an accredited ambulatory center; accreditation may include, but is not limited to AAAHC, JCAHO, state-approved agencies and Medicare-approved facilities. • Are board certified in an American Board of Medical Specialties (ABMS)-approved surgical subspecialty, or other surgical specialty deemed equivalent by the AACS, including: Cosmetic Surgery, Dermatology, General Surgery, Obstetrics and Gynecology, Ophthalmology, Oral and Maxillofacial Surgery, Otolaryngology, Plastic and Reconstructive Surgery • If an applicant has completed an AACS-approved training program and is certified by the American Board of Cosmetic Surgery (ABCS), then the applicant need only provide fifty (50) surgical cases.Fellows are the only category of membership with full membership rights as recognized under customary parliamentarypractice, including but not by way of limitation, the rights to attend membership meetings, to participate in discussion at suchmeetings, to vote, to be a candidate for elective office and to accept appointment to committees.Application requirements:❏ Curriculum Vitae ❏ Copy of board certification ❏ Web profile form❏ Copy of valid medical license ❏ Endorsement form ❏ Ambulatory Accreditation❏ Copy of DEA license ❏ 100 cosmetic surgical case listing certificate or letterApplicants whose specialties fall within the seven named specialties above but do not yet meet the requirements for Fellow,should apply as an Associate member.ASSOCIATEAssociate membership may be granted to any physician or oral and maxillofacial surgeon who meets the following criteria: • Is actively engaged on a regular basis in the performance of cosmetic surgery, but who does not meet Fellow member requirements. • Original specialty of training falls within an American Board of Medical Specialties (ABMS) – approved surgical subspecialty, or other surgical specialty deemed equivalent by AACS including: Cosmetic Surgery, Dermatology, General Surgery, Obstetrics and Gynecology, Ophthalmology, Oral and Maxillofacial Surgery, Otolaryngology, Plastic and Reconstructive SurgeryApplication requirements:❏ Curriculum Vitae ❏ Copy of board certification ❏ Cosmetic Surgery Background Form❏ Copy of current medical license (if applicable)❏ Copy of DEA license ❏ Endorsement formAssociate physicians who have completed three years as an Associate and meet Fellow requirements will be encouraged toupgrade to Fellow. American Academy of Cosmetic Surgery | 737 N. Michigan Ave Suite 2100 | Chicago, IL 60611-5405 USA Phone 312.981.6760 Fax 312.981.6787 | E-mail membership@cosmeticsurgery.org | Website: www.cosmeticsurgery.org
  • Categories Of Membership (continued)AFFILIATEAffiliate membership may be granted to any physician who is engaged in the performance of cosmetic surgery but whosespecialty of training falls outside the ABMS approved specialties listed above. Affiliate specialties may include: internalmedicine, emergency medicine, family practice, etc.Application requirements: Curriculum Vitae❏ ❏ Copy of DEA license ❏ Cosmetic Surgery Background form❏ Copy of current medical license ❏ Endorsement formINTERNATIONALInternational membership may be granted to any physician or oral and maxillofacial surgeon who is engaged in the performanceof cosmetic surgery but who resides in any country other than the United States or Canada.Application requirements: Curriculum Vitae❏ ❏ Endorsement form ❏ Copy of current medical license ❏ Cosmetic Surgery Background formRESIDENTResident membership may be granted to any physician who is participating in residency or fellowship training and who has aninterest in the field of cosmetic surgery. Upon completion of their residency or training program they will be obligated to applyfor an upgrade to either Associate or Fellow member status, prior to the next fiscal year.In addition to the application, the following documents must be submitted in order to be considered for Resident membership: ❏ Curriculum Vitae ❏ Endorsement form (signed by❏ Copy of current medical license residency or fellowship director including start and end dates of program)APPLICATION PROCESSUpon receipt of a completed application and application fee, the application is then forwarded to the Credentials Committeefor review. The Credentials Committee recommends approval of applications to the Board of Trustees, provided allrequirements are met. Final approval is given by the Board of Trustees. There are three (3) Board of Trustees meetings eachyear where applications are approved; spring, fall and the annual meeting, usually held in January. You will be notified by mailapproximately two to three weeks following a board meeting regarding the status and your membership certificate will followshortly after, upon approval. Applications are good for one year from the time they are received at AACS headquarters. Afterone year, if all application materials are not complete, the application will be closed and the applicant will have to reapply fromthe beginning of the application process. Any fees paid will remain the property of the Academy.PAYMENT SCHEDULEIf you are applying for regular membership in the AACS and submit your application during the first three quarters (October-June) of the fiscal year, please send the full application fee for payment. You will be invoiced for the regular membership fee atthe start of the next fiscal year. If you apply and submit payment during the last quarter (July-September) of the fiscal year, yourapplication fee will also serve as payment for the next fiscal year.If you are applying to upgrade your membership status during the first quarter of the fiscal year (October-January), youare required to pay the application processing fee of $100, plus the difference in dues. If you are applying to upgrade yourmembership status during the last three quarters of the fiscal year (February-September), the application processing fee is $100,and you will be invoiced for your upgraded category of membership at the start of the next fiscal year. American Academy of Cosmetic Surgery | 737 N. Michigan Ave Suite 2100 | Chicago, IL 60611-5405 USA Phone 312.981.6760 Fax 312.981.6787 | E-mail membership@cosmeticsurgery.org | Website: www.cosmeticsurgery.org View slide
  • AACS Membership ApplicationPlease print clearly or typeFULL NAME Last First Middle Initial TitleMEDICAL DEGREE: ❏ MD ❏ DO ❏ DDS ❏ DMDBUSINESS ADDRESS Address City State Zip CountryPHONE FAxE-MAIL WEBSITEHOME ADDRESS Address City State Zip CountryHOME PHONE HOME FAxPREFERRED MAIL: ❏ BUSINESS ❏ HOME PREFERRED BILL: ❏ BUSINESS ❏ HOMEDATE OF BIRTH: PLACE OF BIRTH: (State/Province Country)LICENSE INFORMATION:MEDICAL NUMBER STATE / COUNTRY DATE OBTAINEDDENTAL NUMBER STATE / COUNTRY DATE OBTAINEDIS YOUR LICENSE IN EFFECT AND UNRESTRICTED? ❏ YES ❏ NO (Please explain on separate sheet)DEA CERTIFICATE NUMBERSPECIALTY OF CURRENT OR COMPLETED RESIDENCYBOARD CERTIFIED? ❏ YES ❏ NO WHICH BOARD? DATE CERTIFIEDABMS AREA(S) OF SURGICAL TRAININGANY CURRENT OR PREvIOUS MALPRACTICE SUITS? ❏ YES (Please explain on separate sheet) ❏ NOANY CURRENT OR PREvIOUS DISCIPLINARY ACTIONS? ❏ YES (Please explain on separate sheet) ❏ NOACTIvE MEMBERSHIP IN (check all that apply)❏ American Medical Association ❏ American Dental Association ❏ American Osteopathic Association❏ American College of Surgeons ❏ Other (list here)PRIMARY SPECIALTY (please indicate here)❏ Cosmetic Surgery ❏ Dermatology ❏ General Surgery❏ Obstetrics and Gynecology ❏ Ophthalmology ❏ Oral and Maxillofacial Surgery❏ Otolaryngology ❏ Plastic and Reconstructive Surgery View slide
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  • Surgical Case Listings (for Fellow applicants only)The following section has the guidelines for you to use when producing your case list. Surgical cases presented for reviewmust have been completed during a two (2) year period prior to application, with the applicant performing as the independentsurgeon. Your listing must contain a variety of major cases (3 or more) or appropriate surgical experience as determined by themembership committee. If an applicant has completed an AACS-approved training program and is certified by the AmericanBoard of Cosmetic Surgery (ABCS), then the applicant need only provide fifty (50) cases.We realize the CPT book and insurance companies allow unbundling of procedures, but as an applicant for Fellow, your caselist of 100 procedures during the previous 12 months will be counted as follows: procedures such as augmentations, reductions,implants, osteotomies, liposuction, etc., where there is a right and a left side, will be considered bilateral and count only asone case.Chemical peel cases must list: a) agent used, b) strength, and c) anatomic area(s) treated. Dermabrasion and laser resurfacingcases must show the anatomic units treated.If your case list is not numbered, in order, clearly showing all required information, it will be returned to you for revision beforeit is considered. Please contact Membership Services at 312.981.6760 if you have any additional questions.Please use the following cases in order to complete your 100 case listing. In order for your case listing to be considered it mustpresent a variety (3 or more types of cases) from the major category or appropriate surgical experience as determined by themembership committee.ACCEPTABLE MAjOR CASES (75% OF TOTAL CASES) ARE:• Abdominoplasty (Facial Implant) • Otoplasty• Blepharoplasty • C02 Laser of Face • Post Bariatric reconstruction (4 lids count as 2 cases) • Dermabrasion (thighlift, flanklift, adominoplasty)• Bracheoplasty • Fat Transplantation • rhinoplasty including reduction• Breast Augmentation and augmentation • Genioplasty• Breast reduction • Soft Tissue Augmentation • Hair Transplant (Gore-Tex, others, etc.)• BrowLift • Laser Skin resurfacing • Surgical Facial rhytidectomy• Buccal Fat extraction • Liposuction (Necklift, Upper Facelift/ Lower Facelift/• Buttock Implant • Mastopexy Mid Facelift/ Foreheadlift)• Calf Implant • nasal Implant / Augmentation • Scalp Flaps• Chemical Peels • Open Breast Capsulectomy/otomy • Scalp reduction (i.e., Phenol, TCA) • Thighplasty • Osteomy(ies) of Maxilla and Mandible• Chin / Cheek Implant (i.e., medial and posteria)ACCEPTABLE MINOR CASES (25% OF TOTAL CASES) ARE:(Only five cases from each will be counted, and the aggregate number from all cannot exceed 25 cases.)• Botox® Injection • resurfacing (i.e., Radiofrequency, intense pulse light• Cosmetic Tattooing and Aptos)• Injection of Filler Substances • Scar Dermabrasion (i.e., Collagen, Hylaform, other) • Scar Laser resurfacing• Injection Sclerotherapy of Cutaneous Ectasia • Scar revision• Labiaplasty • Skin Grafts• Laser Destruction of Tattoos • Superficial Chemical Peels (Glycolic, Jessner, TCA 35% concentration)• Laser Surgery of Vascular Lesions • Vaginoplasty• Laser Surgery of Pigmented Lesions (vaginal rejuvenation)• Local Skin Flap reconstruction American Academy of Cosmetic Surgery | 737 N. Michigan Ave Suite 2100 | Chicago, IL 60611-5405 USA Phone 312.981.6760 Fax 312.981.6787 | E-mail membership@cosmeticsurgery.org | Website: www.cosmeticsurgery.org
  • Surgical Case Listings (for Fellow applicants only)list of Operative Procedures Performed by:Full NameFrom To (dates) All information must be provided in the format shown by the sample below. NUMBER HOSPITAL OFFICE PATIENT INTIALS DATE OF PROCEDURE PROCEDURE (CHECk ONE) PERFORMED(SAMPLE) X R.W. 01/01/08 DERMABRASION1.2345678910111213141516171819202122232425262728293031323334 American Academy of Cosmetic Surgery | 737 N. Michigan Ave Suite 2100 | Chicago, IL 60611-5405 USA Phone 312.981.6760 Fax 312.981.6787 | E-mail membership@cosmeticsurgery.org | Website: www.cosmeticsurgery.org
  • Surgical Case Listings (for Fellow applicants only) NUMBER HOSPITAL OFFICE PATIENT INTIALS DATE OF PROCEDURE PROCEDURE (CHECk ONE) PERFORMED35363738394041424344454647484950515253545556575859606162636465666768 American Academy of Cosmetic Surgery | 737 N. Michigan Ave Suite 2100 | Chicago, IL 60611-5405 USA Phone 312.981.6760 Fax 312.981.6787 | E-mail membership@cosmeticsurgery.org | Website: www.cosmeticsurgery.org
  • Surgical Case Listings (for Fellow applicants only) NUMBER HOSPITAL OFFICE PATIENT INTIALS DATE OF PROCEDURE PROCEDURE (CHECk ONE) PERFORMED69707172737475767778798081828384858687888990919293949596979899100 American Academy of Cosmetic Surgery | 737 N. Michigan Ave Suite 2100 | Chicago, IL 60611-5405 USA Phone 312.981.6760 Fax 312.981.6787 | E-mail membership@cosmeticsurgery.org | Website: www.cosmeticsurgery.org
  • Website Profile (for Fellow applicants only)FULL NAME Last First Mid Initial Degree❏ MALE ❏ FEMALEPRIMARY OFFICE ADDRESS Address City State Zip CountryPHONE FAx HOURS OF OPERATIONE-MAIL WEBSITEADDITIONAL OFFICE(S) (you may list up to two (2) additional offices with corresponding hours and contact information.)ADDITONAL OFFICE ADDRESS Address City State Zip CountryPHONE FAx HOURS OF OPERATIONADDITONAL OFFICE ADDRESS Address City State Zip CountryPHONE FAx HOURS OF OPERATIONMEDICAL EDUCATIONRESIDENCYFELLOWSHIPBOARD CERTIFICATION(S)LANGUAGES SPOkENADDITIONAL COMMENTS (200 words maximum)This section is for your additional comments to prospective patients. You may wish to include accreditation, hospital privileges, years inpractice, other professional affiliations, special honors or other information of interest about you and your practice.
  • Website Profile (continued)Patients will be able to search for a physician that performs the procedure(s) they are interested in.Please indicate the procedures you currently offer.PROCEDURES OFFERED (please check all that apply)BODY CONTOURING❏ Abdominoplasty ❏ Calf Implants❏ Breast Implants ❏ Gynecomastia❏ Breast lift ❏ Thigh Lift❏ Breast Reduction ❏ liposuction❏ Buttock Implants ❏ Upper Arm lift❏ Buttock liftFACIAL COSMETIC SURGERY❏ Blepharoplasty ❏ lip Implant❏ Facelift ❏ Malar Augmentation❏ Forehead lift ❏ Otoplasty❏ Genioplasty ❏ RhinoplastyNON-INvASIvE TREATMENTS❏ Botox® ❏ laser Resurfacing❏ Chemical Peels ❏ Microdermabrasion❏ Collagen Injections ❏ Radiance❏ Dermabrasion ❏ restylane / Hylaform❏ Fat Injections ❏ ThermageOTHER (please add as needed)❏ Hair Transplant / restoration❏ Laser Hair removal❏ Penile Enlargement❏ Sclerotherapy❏ Tattoo Removal❏ I will e-mail my photo. (Please include your full name and e-mail jpg, bmp or tif files to info@cosmeticsurgery.org – preferred method.)❏ Please use enclosed photo. (Please label your photo. All photos will be kept by AACS.)❏ I do not wish to have a photo on the website. American Academy of Cosmetic Surgery | 737 N. Michigan Ave Suite 2100 | Chicago, IL 60611-5405 USA Phone 312.981.6760 Fax 312.981.6787 | E-mail membership@cosmeticsurgery.org | Website: www.cosmeticsurgery.org