Clinical Consult Program

The Clinical Consult Program will provide a one-on-one forum in which a preceptor (a specialist in treating spasticity, muscle overactivity, and spastic paresis) can mentor a participating physician (a practicing neurologist or physiatrist who is interested in improving their spasticity management skills). In a ¾-day program, the preceptor will review patients with spasticity or other conditions that result from upper motor neuron syndrome with the participating physician at the physician’s or preceptor’s office, clinic, or institution. If participating physicians host a Clinical Consult at their office, they will be responsible for scheduling 2-5 patients with spasticity to share with their preceptor and for completing a Patient Qualification and Selection Checklist for each patient selected, which will be sent to their preceptor to review before their Clinical Consult. Participating physicians will be asked to complete a Preprogram Questionnaire, which will be shared with their preceptor before the Clinical Consult, and a Postprogram Questionnaire ~1 month after, to measure the effectiveness of this CME program. The goal of the Clinical Consult Program is to increase participating physicians' skills with differential diagnosis, identifying appropriate treatment options, setting goals, and reviewing protocols for various pharmacologic therapies.

For more detailed information and frequently asked questions, please click here.

If you are a neurologist or physiatrist and would like to be mentored by a preceptor in this Clinical Consult Program, please complete the Clinical Consult Nomination Form.

* = required field.

Clinical Consult Nomination Form

 
 
*Registration code: 
NRCC07
SPT101
N/A

Your registration code is located in the lower left corner of your invitation. If there is no code on your invitation, please select N/A.
*First Name: 
*Last Name: 
MI: 
*Degree: 
*Title: 
Specialty: 
Years in practice: 
*Affiliation: 
Hospital-based University-based
       
Private practice Clinic
       
Other (Please specify.)
 
*Address: 
*City: 
*State: 
*ZIP
*Office Phone: 
 (eg, xxx-xxx-xxxx)
Ext.: 
Fax: 
*E-mail: 
This e-mail address will be used to contact
you for scheduling.
Best time to contact: 
   
Administrative Assistant: 
Office Phone: 
 (eg, xxx-xxx-xxxx)
Ext.: 
Fax: 
E-mail: 
This e-mail address will be used to contact
you for scheduling.
Best time to contact: 
   
   
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*Please select whether you would like to host the Clinical Consult at your office, clinic, or institution, or travel to a preceptor's office for the Clinical Consult.

 
Host Clinical Consult
 
Travel to a preceptor's office
If you would like to travel to a preceptor's office, please indicate how far you are willing to travel.
 
If you would like to host the Clinical Consult, can 2 patients with spasticity be scheduled?
 
Yes No
       
Does your office have the necessary tools to treat patients with spasticity using chemodenervation therapy,* if applicable?
 
Yes No
       
*What is your comfort level with therapeutic injections?
 
Very comfortable Somewhat comfortable
       
Not comfortable    
       

*Briefly describe your experience in the diagnosis and management of spasticity and other muscle overactivity conditions and your exposure to and aptitude in various treatment modalities, including chemodenervation agents. Explain your interest and desire in improving your spasticity management skills.

 
How did you hear about this program?

 
*Because of the educational nature of this program, the costs of treatment will not be reimbursed. Patients scheduled for the NeuroRehab Clinical Consult program should be billed through their insurance as they would for a regularly scheduled visit.

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The NeuroRehab Preceptor Program is jointly sponsored by the Annenberg Center for Health Sciences at Eisenhower and CogniMed Inc.

This program is supported by an independent educational grant provided by Allergan, Inc.

© 2010 CogniMed Inc. All rights reserved.