Office Gynecology 2012


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Office Gynecology 2012

  1. 1. office gynecology A National Conference for MDs, NPs, CNMs, PAs and RNs sNOWMASS, coLORADO August 5-8, 2012 Special Session • August 6 NEXPLANON® (etonogestrel implant) Clinical TrainingRegister Early and Save!(see page 6 for details)Earn up to 17.5 CE Hours
  2. 2. You’re Invited Who Should Attend?Attend the 10th annual national conference, Office If you are a …Gynecology, where your clinical challenges will be Physician Assistant Family Physicianaddressed, the latest research will be translated intopractical clinical application, and evidence-based Obstetrician/Gynecologist Registered Nurseapproaches for managing a variety of health issues women Women’s Health, Family Anyone else providingface will be presented. Designed for MDs, NPs, CNMs, or Adult Nurse Practitioner health care for womenPAs and RNs from women’s health and family practicesettings, this conference brings together a stellar panel Certified Nurse-Midwife ... this conference is for you!of clinician experts to address the clinical challenges youmanage daily. Bring your questions and puzzling cases …our dynamic faculty will give you answers and guidance. AccreditationHighlights of the 2012 Conference Include: A Certificate of Attendance will be available online after you A number of “Hot Topics,” issues you deal with in your complete the course requirements, enabling you to register your every day practice, addressed in a variety of teaching credit with the appropriate licensing boards or associations. formats, including didactic sessions, faculty panels, Concurrent Sessions, interactive case study Physicians discussions and skills labs. Contemporary Forums is accredited by the Accreditation A stellar panel of faculty experts who will share their Council for Continuing Medical Education to provide perspectives and insights on providing comprehensive, continuing medical education for physicians. evidence-based care for women. Contemporary Forums designates this Live Activity for An optional Special Session NEXPLANON® Clinical a maximum of 17.5 AMA PRA Category 1 CreditsTM. Training, where you will learn insertion and removal Physicians should claim only the credit commensurate with procedures for the next generation of this long-acting the extent of their participation in the activity. method of contraception, providing your patients with Application for cognate credits has been filed with the another option and your practice with additional revenue. American Congress of Obstetricians and Gynecologists. Access to the Online CE Library where you can listen Determination of credit is pending. to sessions you couldn’t attend and reference important Application for CME credit has been filed with the American session details after the conference. Academy of Family Physicians. Determination of credit is95% of the clinicians who responded to our post-conference pending.survey for the 2011 “Office Gynecology” conference said Nurses and Nurse Practitionersthey had made changes in practice based on what theylearned and that those changes had positively impacted Contemporary Forums is accredited as a provider ofthe health of their patients. Isn’t this what you expect from continuing nursing education by the American Nursescontinuing education? Join your colleagues and the faculty Credentialing Center’s Commission on the magnificent setting of Snowmass/Aspen and the This activity is approved for 17.5 contact hours.Rocky Mountains where we have designed a schedule Contemporary Forums is approved by the California Board ofwhich encourages interprofessional learning as well as Registered Nursing, Provider #04516. This activity is approvedrelaxation and exploration with family and friends. See you for 21 contact hours. (CA BRN contact hour = 50 minutes)there!Anita L. Nelson, MD Nurse-MidwivesProfessor of OB/GYN The Continuing Education Committee of the AmericanDavid Geffen School of Medicine at UCLA College of Nurse-Midwives grants reciprocity statusPam Jenkins-Wallace, MS, NP to the Accreditation Council for Continuing MedicalVice President, Program Development Education (ACCME) for Category 1 offerings, providingContemporary Forums the program is relevant to nurse-midwifery. A maximum of 17.5 hours may be reported. Physician Assistants The American Academy of Physician Assistants accepts Category 1 CME approval from organizations accredited by the ACCME to grant Category 1 hours toward the Physician’s Recognition Award. PAs may report up to 17.5 hours of credit. Pharmacology Credit for Prescriptive Authority A maximum of 6.5 hours in pharmacology may be earned by attending this conference. indicates sessions with pharmacology content. Because states’ requirements vary, contact your Board of Nursing for more information. Note: There is no CE credit for the Special Session NEXPLANON® Clinical Training.2 Visit us at to register today • Follow us on Facebook and Twitter (#OfficeGyn12)
  3. 3. Snowmass, Colorado estled in the shadow of the Rocky Mountains, Snowmass Village is a sparkling jewel in a valley lush with wildflowersN where outdoor recreational opportunities are complimented by cultural programs and music festivals. Ride theGondola to the top of the mountain and hike or mountain bike the numerous trails, run the whitewater rapids, or soar in aglider or hot air balloon, go fly fishing, horseback riding or play a round of golf in this scenic valley. Shopping is abundantat the Snowmass Village Mall, a European designed outdoor mall with a variety of shops and restaurants.Snowmass is a family resort, providing numerous activities forkids and their parents. And the Village offers complimentary Area Activitiesshuttle service around the property and to the Village Mallevery 15 minutes. You won’t want to miss the Snowmass Blazing Adventures will be the on-site activityVillage Rodeo or gather family and friends for Snowmass coordinator and will mail a complete activity/reservationMusic and Movie Night on Fanny Hill, where you’ll enjoy a packet once you have registered for the concert with locals and visitors alike. Please call Blazing Adventures with any questions after you have received the information.For over 50 years, music lovers, students and seasonedperformers have gathered during the summer in the • Whitewater River Rafting • Hot Air Balloon RideSnowmass/Aspen area to share their love of music. The • Float Trip • Rock Climbing • Evening Jeep Ride and • Kayak SchoolAspen Music Festival features several classical music Sunset Dinner • Aspen Music Festivalevents each day, from orchestral performances, to chamber • Horseback Rides • Snowmass Rodeo and Dinnermusic and lavish operas. • Fly Fishing … and more! • Wildlife ExpeditionsWith free bus service twice hourly between SnowmassVillage and Aspen, you’ll find it easy to enjoy allAspen offers … world-class restaurants and shopping,breathtaking views and perhaps even a celebrity sighting or Websites to Visittwo! You may want to join the special tour from Aspen to the www.jazzaspensnowmass.comMaroon Bells, three mountain peaks which tower above www.treehousekidsclub.comMaroon Lake, where you can take a scenic stroll or tackle www.snowmassiceage.coma vigorous hike. Don’t miss this opportunity to combinean outstanding educational experience with a delightful“R and R” from your busy life! RAVE REVIEWS! “I have always been happy with Contemporary Forums “Faculty were very knowledgable, accessible and workshops, but this was the best conference I have enthusiastic.” attended in my years as a Women’s Health Care NP. I Cynthia Martin, MD • Englewood, CO will not hesitate to attend more Contemporary Forums “Excellent conference! Varied topics with cutting edge conferences.” information! Very relevant to practice.” Brenda Willkom, WHNP-BC • Billings, MT Jill Breach, ARNP, CNM, FNP-C • Creston, IA “I thought it was an excellent conference with emphasis “Excellent conference. I am a PA who works in primary on the clinical application to my practice. Loved it!” care and I do a lot of women’s health. This conference Donna Wilkinson, ARNP-C • St. Petersburg, FL was perfect for my line of work!” “The best conference I have attended. Every topic was Kristen Mace, PA-C • Williamstown, PA relative to my practice and so many pearls to improve my practice. The accommodations were excellent.” Dori Vojta, CNM, CNP • Mobridge, SD A Leader in Quality Continuing Education for Healthcare Professionals for 30 years 3
  4. 4. Conference Faculty Conference ScheduleEliza Buyers, MD, FACOG Saturday, August 4Medical DirectorYoung Women’s Health ProgramThe Rocky Mountain Youth Clinics 4:00 – Registration • Welcome ReceptionThornton, Colorado 5:30 p.m.Julia A. Files, MDConsultant, Medallion Program Sunday, August 5Mayo Clinic ArizonaAssistant Professor of MedicineMayo Clinic College of Medicine 7:00 a.m. RegistrationScottsdale, Arizona Continental Breakfast for Conference ParticipantsSusan E. Hoffstetter, PhD, WHNP-BC, FAANP 8:00 Managing Acute and Chronic HeavyAssociate Professor, Division of Urogynecology Menstrual BleedingCo-Director, Vulvar and Vaginal Disorders Specialty Center Anita L. Nelson, MD ( = .25 hr.)St. Louis University School of MedicineSt. Louis, Missouri 9:00 Vulvar Disease: Test Your Skills Susan E. Hoffstetter, PhD, WHNP-BC ( = .25 hr.)Amer Karam, MDAssistant Clinical Professor, Obstetrics and Gynecology 9:45 Refreshment BreakDivision of Gynecologic OncologyDavid Geffen School of Medicine at UCLA 10:15 Understanding PCOS: It’s Not asLos Angeles, California Complicated as It Seems Beth J. Plante, MD ( = .25 hr.)Anita L. Nelson, MDConference Chair 11:00 Bioidentical Hormones: Do They Have AProfessor of Obstetrics and Gynecology Place in Menopause Symptom Management?David Geffen School of Medicine at UCLA Julia A. Files, MD ( = .5 hr.)Medical Director, Women’s Health Care ProgramsHarbor-UCLA Medical Center 11:45 Infertility 2012: An Update onTorrance, California Reproductive Technology Beth J. Plante, MD ( = .25 hr.)Beth J. Plante, MDClinical Assistant Professor of Obstetrics and Gynecology 12:30 p.m. Questions and DiscussionDivision of Reproductive Endocrinology and Infertility Faculty Panel ( = .25 hr.)Women and Infants HospitalBrown University Warren Alpert Medical School 1:00 AdjournProvidence, Rhode IslandAdjunct Assistant Professor of Obstetrics and GynecologyTufts University School of MedicineBoston, Massachusetts Monday, August 6 7:00 a.m. Continental Breakfast for Conference Participants 8:00 Breast Cancer: Identification and Management of High-Risk Patients Conference Objectives Amer Karam, MD ( = .25 hr.) 8:45 Amenorrhea in Adolescents: Discuss clinical management of a variety of complex To Treat or Not to Treat conditions in women’s health including abnormal Beth J. Plante, MD ( = .25 hr.) bleeding, genital herpes, recurrent vaginitis, PCOS, vulvar disease, GYN pain syndromes and others. 9:30 Refreshment Break Examine the role of bioidentical hormones as an option 10:00 Chronic Pain Syndromes: Vulvodynia for menopause symptom management. and Interstitial Cystitis Through case-based discussion, strategize safe and Susan E. Hoffstetter, PhD, WHNP-BC ( = .25 hr.) effective contraceptive choices for women with chronic 10:45 Menopause Management: Interesting Cases medical conditions. Anita L. Nelson, MD ( = .5 hr.) Utilize current screening guidelines for a variety of Julia A. Files, MD health conditions including GYN cancer, STDs and Susan E. Hoffstetter, PhD, WHNP-BC cardiovascular health. 11:45 Genital Herpes: Clinical and Participate in interprofessional, interactive learning Counseling Imperatives through case studies, skills trainings, faculty panels and Eliza Buyers, MD, FACOG ( = .25 hr.) collegial collaboration. 12:30 p.m. Questions and Discussion Faculty Panel ( = .25 hr.) 1:00 Adjourn4 Visit us at to register today • Follow us on Facebook and Twitter (#OfficeGyn12)
  5. 5. Monday, August 6 - continued Tuesday, August 7 - continued SPECIAL SESSION 2:00 – 5:00 p.m. 10:45 CONCURRENT SESSIONS #3 #31 You’ve Found a Pelvic Mass: Now What? Clinical Training Program Amer Karam, MD NEXPLANON® (etonogestrel implant) #32 Overactive Bladder Syndrome and (Limited to 50. Requires separate registration fee. Register early!) Menopause: Are They Related? During the Clinical Training Program for NEXPLANON® Susan E. Hoffstetter, PhD, WHNP-BC ( = .25 hr.) (etonogestrel implant) you will receive hands-on training for insertion and removal procedures as well 11:45 Session Change as implant localization techniques. Completion of 12:00 p.m. CONCURRENT SESSIONS #4 this course will allow you to order the product from authorized distributor(s). #41 Premature Ovarian Failure: A Systematic This session, which is sponsored by Merck, is not Approach to Evaluation and Management accredited for continuing education credit. The Beth J. Plante, MD ( = .25 hr.) training is open only to advanced practice clinicians #42 Effective Strategies for Communicating with furnishing numbers or prescribing privileges in with Teens About STDs their state. It is Merck’s policy to verify all clinicians’ Eliza Buyers, MD, FACOG practice, license, and eligibility information in advance of the training. Merck will contact you directly if there is #43 Introduction to Pessary Fitting (Space is limited to 40. Register early!) a problem. Attendees are expected to attend the entire training which is approximately 3 hours in duration. Anita L. Nelson, MD Certificates of attendance will not be issued to those Julia A. Files, MD who arrive late or leave early. Susan E. Hoffstetter, PhD, WHNP-BC WOMN-1006660-0000 12/11 1:00 AdjournTuesday, August 7 Wednesday, August 8Choose one topic in each time period and note your 7:00 a.m. Continental Breakfast for Conference Participantsselection on the Registration Form. 8:00 Contraceptive Choices for Women with 7:00 a.m. Continental Breakfast for Conference Participants Chronic Disease: Case Studies Anita L. Nelson, MD ( = .75 hr.) 8:00 CONCURRENT SESSIONS #1 8:45 GYN Cancer Screening: What Makes Sense? #11 Oral Contraceptives and Perimenopause: Amer Karam, MD Management Strategies for a Smoother Transition 9:30 Refreshment Break Julia A. Files, MD ( = .75 hr.) 9:45 Heart Disease in Women: #12 STD Management: Challenging Cases Strategies for Prevention Eliza Buyers, MD, FACOG ( = .25 hr.) Julia A. Files, MD ( = .25 hr.)9:00 Session Change 10:30 Abnormal Pap Management: Incorporating the New Guidelines9:15 CONCURRENT SESSIONS #2 Amer Karam, MD #21 Osteoporosis Screening and Treatment: 11:15 Resilience and the Importance Practice FRAX of Self-Care for Clinicians Anita L. Nelson, MD ( = .25 hr.) Julia A. Files, MD #22 Chronic and Recurrent Vaginitis: 12:00 p.m. Questions and Discussion What Do We Have to Offer? Faculty Panel ( = .25 hr.) Susan E. Hoffstetter, PhD, WHNP-BC ( = .5 hr.) 12:45 Adjourn10:15 Refreshment Break = Pharmacology for Advanced Practice Clinicians A Leader in Quality Continuing Education for Healthcare Professionals for 30 years 5
  6. 6. Registration Information Registrations must include full tuition payment to be accepted. Registrations faxed without payment will not be processed. Conference communications are sent via email. When registering please provide attendee’s best email address as some emails are filtered and blocked. Since conference registration and hotel rooms are limited, early registration is advised. Out of consideration to registrants, children of any age and spouses may not attend the sessions. Tuition (U.S. Funds) Nurses, PAs, Special Session Physicians **Residents, Others NEXPLANON® Clinical Training Early Registration Fee* (On/Before June 25) $595 $495 $95 Regular Registration Fee $645 $545 $95 (After June 25)* Postmarked or phone/fax/online registration and fees received on/before June 25.** Residents: To qualify, submit facility verification of status with registration.Your tuition includes Welcome Reception, Continental Breakfast daily, Certificate of Attendance, and online access to posted presentation handoutsbefore and after the conference. In addition, you will have complimentary Online CE Library access to all the recorded Conference sessions for2 years and may earn additional CE credit online free of charge for Concurrent Sessions you did not attend. See page 7 for Library details. Group Discounts (Mail, fax or call in together. Online registration is not available.) Tuition discounts are given to groups of 3 or more registering for the complete conference. Discounts do not apply to the Special Session. To qualify for the group discount, all registration information must be complete for all group members, payment included and forms sent together. If faxing, list all group members on cover sheet. Subtract the discount from the tuition fee. Groups may not be formed after individual registrations are received. $25 per person discount for 3 or 4 in a group $45 per person discount for 5 or more in a group Method of Tuition Payment Make payment by check (payable to Contemporary Forums and enclose with Registration Form), Visa, MasterCard, Discover, American Express or Purchase Order. A $30 fee is charged for any returned check. Personal checks are NOT accepted at the conference. Purchase Orders must be received with registration by the conference date and include the P.O. number, invoice address, tuition, approval signature, contact name, email address and phone number. Register Online, or by Phone, Fax or Mail (Payment is required to register.) Register only ONCE, online at, by mail or fax (800) 329-9923, or call (800) 377-7707, Monday-Friday, 8 a.m. - 5 p.m. (Pacific Time). Before calling, complete all registration information. Tax Deductibility Expenses of training, tuition, travel, lodging and meals to maintain or improve professional skills may be TAX DEDUCTIBLE. Consult your tax advisor. Partial Attendance (Online registration is not available.) Call Contemporary Forums for tuition and CE credit for individual days. Group discounts do not apply. Registrations may not be shared. Cancellations Cancellations may be made by phone or in writing. Cancellations received on/before June 25 receive a full tuition refund. Cancellations received after June 25 are assessed a $20 processing fee. No refunds for cancellations received after the conference begins or for “no shows.” If this meeting is cancelled for any reason, including labor strikes or acts of God, liability is limited to a full refund of registration fees. Program Changes Contemporary Forums reserves the right to make necessary changes in speakers, topics or schedule. The most current program can be found on our website. Questions? Contact Contemporary Forums at (800) 377-7707, Monday - Friday, 8 a.m. - 5 p.m. (Pacific Time) or email If you require special arrangements at this conference, call (800) 377-7707, at least 30 days prior to the conference.EASY WAYS TO REGISTER Online (Credit card only) Fax (Credit card or Phone (Credit card only) Mail - Attn: Registrar Visit us at Purchase Order) Monday - Friday Contemporary (800) 329-9923 (800) 377-7707 6377 Clark Avenue, Ste. 200 24 hours a day 8am - 5pm, Pacific Time Dublin, CA 94568 6 Visit us at to register today • Follow us on Facebook and Twitter (#OfficeGyn12)
  7. 7. Accommodations & Rates Travel DiscountsThe conference will be held at the Snowmass Village Contemporary Forums has a special discountConference Center, located in the center of Snowmass agreement with United Airlines unavailableVillage. Condo accommodations located in the vicinity of to the general public. To obtain these specialthe Conference Center are being held in a limited block conference fares call the Special Meetingfor you and your guests at special group rates which Desk at (800) 521-4041, Account Code 510CW. Ticketingwill be in effect, based on availability, from August 3 to and payment can be done directly by you or through yourAugust 9 for those wishing to extend their stay to enjoy travel agent. To ensure the best flights and times, sincethe area. Please note: The Silvertree Hotel is closed seats are limited, make your reservations early. Fares arefor renovation. guaranteed at the time of the ticket purchaseTo obtain the special group rates, make your reservation Hertz is the official car rental agencyearly and before the “condo block release date” for the conference. Special rates willwhich is July 5, 2012. Accommodations may sell out be in effect throughout the conference as well as onebefore this date so be sure to make your reservation week before and after. For special rates, call HERTZ atnow. After this date, condos and group rates may no (800) 654-2240 and refer to Contemporary Forums plus thelonger be available so call the condo property directly conference discount code CV#03000259.regarding availability. Phone numbers are listed belownext to each condo facility. Travel OptionsFor condo reservations, call the designated number foreach property listed below and inform them that you Denver is approximately 4 hours driving time fromare attending the Contemporary Forums’ conference Snowmass Village. You may want to consider flying into“Office Gynecology.” Request a confirmation number Denver and renting a car. Flights to Denver may be lessand written confirmation of your reservation as well as expensive or more available than flying directly to Aspen.their deposit requirements and cancellation policies. For To rent a car, call Hertz for special discounted rates andarrivals after 4 p.m., call on the day of travel to reconfirm refer to Contemporary Forums and the conference discountreservations. code CV#03000259.Check with the property you choose regarding CONTEMPORARY FORUMScomplimentary shuttle service to and from Aspen Airport 2012 CONFERENCE CALENDAR (Partial listing)and the other amenities they offer. Rates listed are percondo and subject to prevailing state and local taxes. Pharmacology for Advanced Practice Clinicians San Francisco , CA • September 10-16 Washington , DC • October 8-14ASPENWOOD Reservation number: (800) 420-5797 Las Vegas , NV • November 5-11Deluxe accommodations, Southwestern décor, Ambulatory OB/GYN Nursingfireplaces, balconies, kitchens and surrounding views of Boston , MA • September 27-29the mountains. Easy walk to the Conference Center. Contraceptive Technology: Quest for Excellence Atlanta , GA • November 1-3Rates per day: Studio - $115; Studio plus Loft - $130 For complete conference information, visit, call toll-free at (800) 377-7707 or Reservation number: (800) 420-5797 Contemporary Forums is a division of American Career College.Each unit features a fireplace, private balcony andfully equipped kitchen. Amenities include a heated pooland whirlpool, sauna, high-speed wireless internet andcomplimentary laundry facilities. Online CE LibraryRates per day: Studio - $94; 1-Bedroom - $115 Conference Attendees Registration includes:TERRACEHOUSE Reservation number: (800) 420-5797 Access recorded sessions for 2 yearsDeluxe units featuring fireplaces, kitchens, as well as a Earn additional CE online for Concurrent Sessions freefitness center and Jacuzzi on-site. Walk or shuttle to the Share online sessions with 3 colleaguesConference Center. (CE credit optional $10 per session)Rates per day: 2-Bedroom - $159 Can’t Attend This Live Conference?TIMBERLINE Reservation number: (800) 922-4001 Pre-order online access before 8/4/12 for only $230Deluxe units featuring efficiency kitchen in studios, fully Over 25 hours of ANCC/ACCME credit includedequipped kitchen in all other condos, HD TV, DVD, and Share content with 3 colleagues (CE credit optional)CD player, complimentary wireless internet access, Unlimited online access for 2 yearspool, hot tubs, fitness center and sundeck with barbecues. Online Group AccessRates per day: Studio - $115; 1-Bedroom - $169; Programs Available2-Bedroom - $188; 3-Bedroom - $239 To request group discount pricing and details, visit or call (925) 361-4811. A Leader in Quality Continuing Education for Healthcare Professionals for 30 years 7
  8. 8. Please Post Prominently or Forward to a Colleague if Unable to Attend U.S. POSTAGE Contemporary PRSRT STDRegistration Form: Office Gynecology Forums PAIDSend this form with full payment (U.S. Funds) to:Contemporary Forums, Attn: Registrar, 6377 Clark Avenue, Suite 200, Dublin, CA 94568Fax (800) 329-9923, Phone (800) 377-7707, or visit www.ContemporaryForums.comONLINE CE LIBRARY ONLY (Not Attending Conference - Details/Price Page 7) Conference Content via Library only (Complete all Registration Information, Professional Profile and Payment Summary)OR Please share with your colleaguesREGISTER TO ATTEND: Conference (August 5-8) Special Session: NEXPLANON® Clinical Training (August 6, 2-5 p.m.)REGISTRATION INFORMATION (Please Print Clearly)*Name, License/Degrees, Place of Employment, City, State appear on your badge. Social Security # (Last 4 Digits)*First Name*Last Name *License/Degrees*Place of Employment 6377 Clark Avenue, Ste. 200 Contemporary Forums PDF*City *State Dublin, CA 94568*Attendee’s E-mailofFor confirmation,Online CE Library. Please print clearly priorprovide your best emailto your Certificate Attendance and receipt, access to presentation slides and to conference, accessaddress as some emails are filtered and blocked. Code:Home AddressCity State Zip PAYMENT SUMMARY #073412Daytime Phone(s) Early Fee Postmark Deadline: June 25CONCURRENT SESSIONS SELECTION Conference Content via Library Only $Please check one of the session numbers in each time period. Sessions are limited in sizeand assignments are made in the order received. OR Conference Tuition (Attending) $Tuesday, August 7 (See page 5)8:00 a.m. 11 12 Group Discount (See page 6) -$9:15 a.m. 21 22 (Registration forms must be sent in together)10:45 a.m. 31 32 Special Session: NEXPLANON® Training + $12:00 p.m. 41 42 43 (August 6, 2-5 p.m.)PROFESSIONAL PROFILEChoose ONE category in each section that best applies to you. If you have multiple TOTAL PAYMENT ENCLOSED $roles, select the one that occupies the majority of your time. Use “Other” only if noneof the choices apply to you. OFFICE USE ONLY: C_________ D _________ E _________1. SPECIALTY 3. CLINICAL SETTING Family Planning College Health Service Check/Money Order Payable to Contemporary Forums Family Practice/Primary Care Family Planning Clinic Internal Medicine HMO Nurse-Midwifery Hospital-Based Clinic Credit Card # Obstetrics & Gynecology Hospital Inpatient Women’s Health Military Clinic/Hospital Exp. Date Other:_________________ Multi-Specialty Group OB/GYN Clinic2. LICENSE/PROFESSION Physician Office Print Cardholder’s Name CNM/NM Planned Parenthood FNP/ANP Primary Care Clinic/Office MD/DO - Family Practice Private Practice Billing Address MD/DO - Women’s Health/OB/GYN Public Health/Community Clinic NP - Women’s Health/OB/GYN Rural Health Center PA/PA-C University/Academia City State Zip RN/RNC Other:_________________ Other:_________________ Payer EmailWe collect this data in order to provide you with information about ContemporaryForums, conferences, and the Online CE Library. If you prefer not to receive furtherinformation, please see our Privacy Statement at Payer Phone #