Provider Shadow Program

  Providers Educational Opportunities In order to better fulfill your educational needs, please respond to the following questions: Phone xxx-xxx-xxxx:* Fax   I am a nurse I am a nurse who cares for less than 20 patients with bledding disorders. I am a nurse who cares for more than 20 patients with bledding disorders.   I am a social worker. I am a physical therapist I am a dentist or dental hygenist   I am another healthcare provider, please specify: The state in which I provide services is: The greatest educational need that I have is the:   I would be interested to travel to Chicago, illinois for two-day educational opportunity at the PSP. 1. Basics of blood clotting and the control of coagulation 2. What tipes of problems may be present when blood fails to clot 3. Genetics and molecular biology of hemophila 4. Age-specific scenarios that present in children with hemophilia and other bleeding disorders and the management of these problems 5. Different treatment protocols for various bleeding circumstances 6. Join disease and other musculoskeletal problems encountered in patients with hemophilia 7. The different scoring systems available to asses the musculoskeletal system of patients with hemophilia and other bleeding disorders 8. The risk factors, consequences and complications of inhibitors in hemophilia 9. Management of inhibitors in hemophilia A including the appropriate use of prophylaxis, immune tolerance therapy and immunomodulation 10. Risk factors, consequences and management of viral hepatitis in patients with bleeding disorders 11. The impact of hemophilia on academic achievement 12. The consequences of bleeding disorders on oral health and dentition 13. The impact of bleeding disorders on women who are carriers of the defect 14. The genetics of hemophilia, carrier detection and family counseling 15. The gynecological complications in women with bleeding disorders 16. Platelet function disorders and their presentation and management 17. The clinical presentation, epidemiology, genetics, laboratory diagnosis and management of patients with von Willebrand disease 18. The criteria necessary for making the diagnosis of type 1 von Willebrand Disease. Name:* Company/Organization:* Address:* E-mail:* Please rank the following learning objectives in terms of most important (1) to least important (10) 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10   Verification Protection Code:* Please, enter the text shown in the image into the field below.   I am a physician (MD or DO) I am a physician who cares for less than 20 patients with bledding disorders. I am a physican who cares for more than 20 patients with bledding disorders.