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 preceptor's office, clinic, or institution. Participating physicians will complete a Preprogram Questionnaire, which will be shared with the preceptor before the Clinical Consult, and a Postprogram Questionnaire about 1 month after, to measure the effectiveness of this CME program. Preceptors will host a Clinical Consult at their office. They will be responsible for scheduling 2 to 5 patients with spasticity and completing a Patient Qualification and Selection Checklist for each; the checklists will be sent to the preceptor to review before the Clinical Consult. 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 answers to frequently asked questions,
please click here.

If you would like to be mentored by a preceptor in the Clinical Consult Program, please complete the Clinical Consult Request form below.

* indicates a required field.

Clinical Consult Request

*First name: 
*Last name: 
MI: 
*Degree: 
Title: 
Specialty: 
Years in practice: 
*Affiliation: 
Hospital-based University-based
       
Private practice Clinic
       
Other (Please specify.)
 
*Address: 
Address 2: 
*City: 
*State: 
*ZIP
*Cell phone: 
 (eg, xxx-xxx-xxxx)
  (used as secondary form of contact)
Ext: 
Fax: 
*E-mail: 
This e-mail address will be used as primary contact for scheduling.
Best time to contact: 
   
Administrative assistant name: 
Admin Office phone: 
 (eg, xxx-xxx-xxxx)
Ext: 
Admin Fax: 
Admin E-mail: 
This e-mail address will be used as primary contact for scheduling.
Admin 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 .

 
Host the Clinical Consult
 
Travel to a preceptor's office

*Please indicate how far you are willing to travel to a preceptor's office for the Clinical Consult.
 

*If you would like to host the Clinical Consult, can 2 to 5 patients with spasticity be scheduled?
 
Yes No
       

Does your office have the necessary tools to treat patients with spasticity using chemodenervation therapy,a 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?

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aBecause of the educational nature of this program, treatment costs will not be reimbursed. Any patient scheduled for the NeuroRehab Clinical Consult Program who requires treatment should be billed as they would for a regularly scheduled visit, eg, through insurance.

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Jointly provided by CogniMed Inc and Evolve.

This program is supported by an independent educational grant provided by Merz Pharma.

© 2017 CogniMed Inc. All rights reserved.