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Required format:

mVSPcYnxz4Q5HUeQFNknmEFVG9qTt8gMuykQUfBe27GtBHBL4INtUBK9TmbSDXDxckzXAQUYUo7ZHDtSvzuUkLBVJH8bbwfGF3q5

ECHO Registration: Fall-Winter Session 2022-2023

Thank you for your interest in ECHO Autism & Developmental Disorders! Please enter the following information for our records. This information will be used for attendance purposes and CME/CEU credit.

First Name:

* must provide value

Last Name:

* must provide value

Email Address:

* must provide value

Affiliation:

* must provide value

Work Phone:

* must provide value

Birth Day (MM/DD). This is needed for CME Credit:

* must provide value

Name of Practice:

County of Practice:

Zip Code of Practice:

* must provide value

Area of Practice (ie: Pediatrics, Family Practice, Neurology, etc.)

* must provide value

Primary Degree:

* must provide value

If you are a social worker, please note your license number:

ECHO Autism is a collaboration between our hub team and our participants (spokes). Every session is an opportunity to learn from each other. Therefore, we ask each participant to present at least one case during the course of the program. Cases are on patients in the participant's practice for whom the provider could use assistance with patient management (i.e.: Diagnosis, medication management, management of physical health or behavioral problems, community resources). During the session, the presenter provides a brief overview of the questions and history (without PHI), and then the entire team discusses. For ease of scheduling, please indicate date(s) you would be available to present a case.

* must provide value

September 9

September 23

October 7

October 21

November 4

November 18

December 2

December 16

January 6

January 20

February 3

February 17

March 3

March 17

March 31

Is there a particular topic you are hoping to learn about from this ECHO series?

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If you have any questions, please contact the Project Coordinator, Mary Brzustowicz, at Mary_Brzustowicz@URMC.Rochester.edu

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