FOR POSITION ONLY. Continuous Renal Replacement Therapy. CRR Teams. N o v e m b e r 9 & 1 0, New Location. International Course Director

Similar documents
N o v e m b e r 9 & 1 0, New Location. John A. Kellum, MD Professor of Critical Care Medicine

The University of Pittsburgh School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Stroke Program Development: The Nuts and Bolts

Regional Conference. Friday, November 9, T h e F i r s t U P M C S t. M a r g a r e t

STROKE UPDATE 2015 XIX. Friday, September 18, 2015 XIX. Friday, September 18, Location: Westin Convention Center Hotel

STROKE UPDATE 2018 XXII. Friday, October 26, 2018 XXII. Friday, October 26, Location: Westin Convention Center Hotel

UPMC Adult ECMO Review and Training Course

Friday, March 22, 2013

Update in Hepatology, Gastroenterology, and Transplantation

Title of Educational Activity: 3 rd Annual WISER Symposium on Nursing Simulation. Date: December 3-4, Location: Pittsburgh Airport Marriott

Pediatric Trauma Symposium

An Interactive Forum for General Practitioners and Cardiologists

2015 Professional Immunization Seminar: Power to Protect

Inaugural Three Rivers Antimicrobial Stewardship Symposium

2018 Professional Immunization Seminar:

2016 Professional Immunization Seminar:

A Primary Care Provider s Guide to Cardiology: Update 2007

Our Changing World: New Directions in Community Behavioral Health. June 20, :30 am 4:30 pm Omni William Penn Hotel Pittsburgh, Pennsylvania

HYPOTHERMIA AND RESUSCITATION TRAINING INSTITUTE AT PENN (HART)

Quality in HIV Care: Guaranteeing Good Outcomes for Your HIV Patients. 8th Annual HIV Symposium

2017 Professional Immunization Seminar:

Pediatric Fundamental Critical Care Support Provider Course

Videoconference Series

Advances in Cardiovascular Care

THE 5 TH ALFRED P. FISHMAN SYMPOSIUM:

BLOOD PRESSURE 2017:

Multidisciplinary Medicine on the Bay

Neonatal Resuscitation Program Instructors: Influencing the Future

Obstetrical Neurology Conference

2014 Challenges and Controversies in Emergency Medicine

Orthopaedic Update: Upper Extremity

Primary Care. a neurology update. Saturday, August 25, Conference Directors Drs. Frank Castillon III and Paul A. Solomon

Meeting Location The conference will be held at the Nemacolin Woodlands Resort, 1001 LaFayette Drive, Farmington, PA 15437, Phone (724)

Organization Workshop

A C M E / C N E - A C C R E D I T E D C O N F E R E N C E

CURRENT ADVANCES IN CARDIOVASCULAR CARE 2015

Trauma-Focused Cognitive Behavioral Therapy for Traumatized Children and Their Families

Culturally Responsive. Friday. Health Care in Iowa THE UNIVERSITY OF IOWA PRESENTS

Culturally Responsive. Friday. Health Care in Iowa THE UNIVERSITY OF IOWA PRESENTS

The University of Iowa Carver College of Medicine

Women s Health Conference. Creating a Culture of Patient Centered Care and Safety. February 19-20, Registration Information

NEUROSCIENCE CONFERENCE

23 rd Annual Clinical Reviews and Primary Care Update

STEMI System of Care: Where do you fit in?

pediatric gastroenterology

Symposium. Cardiovascular Medicine. Friday, June 20, 2014 UNIVERSITY OF IOWA DIVISION OF DUCATION ONTINUING EDICAL

Thursday, Sept. 20, Ambassador Banquet and Conference Center 7794 Peach St. Erie, Pa.

Heart Symposium. Saturday February 24, The Dr. Robert S. and Joyce Pate Capper. 7:50 a.m. - 12:30 p.m. Register online at TexasHealth.

Pediatric Fundamental Critical Care Support (PFCCS) Provider Course

Drug User Health: Promoting Health and Reducing Harm in Medical Settings

CURRENT ADVANCES IN HEART & VASCULAR CARE 2018

Cultivating A Culture of Safety in Healthcare

18 th Annual St. Louis Critical Care Update Advances in the Management of the Critically Ill Patient

Where do you fit in? STEMI System of Care. Saturday, May 16, a.m. to 12:15 p.m.

2017 NEUROSCIENCE CONFERENCE

Fall Videoconference Series

Annual Symposium. HIV and Hepatitis C Clinical Care Symposium. 16th Annual

TUESDAY, APRIL 24, 2018 UPDATE ON: CHRONIC KIDNEY DISEASE

Advances in Transplantation Topics in Kidney, Pancreas and Liver Transplant

Registration Brochure. Perioperative Quality and Enhanced Recovery Conference

FRIDAY, FEBRUARY 26, :15 A.M. TO 3:15 P.M.

Pediatric Fundamental Critical Care Support (PFCCS)

Enhancing Person-Centered Care through Advance Care Planning

32 nd Annual Pittsburgh Schizophrenia Conference

Advances in Gynecologic Cancers

Agricultural Safety and Health: The Core Course

Controlled Management

2018 Acute Ischemic Stroke Conference

Gastroenterology. & Hepatology. Gastroenterology. Saturday, September 12, Best Practices & New Developments In

Comprehensive Education for the GI Practice

FRIDAY, FEBRUARY 24, :15 A.M. TO 3:15 P.M.

VANDERBILT TRANSPLANT NURSE PRACTITIONER SYMPOSIUM

NEW SCHOOL NURSE ORIENTATION Friday, August 10, 2018 Mount Mercy University Graduate Center 1650 Matterhorn Dr, NE Cedar Rapids, Iowa

Maintenance of Certification in Anesthesia Simulation Session Saturday, Oct. 27, 2018

Pediatric Fundamental Critical Care Support (PFCCS)

2016 NEUROSCIENCE CONFERENCE

Benign Breast Disease

15TH ANNUAL EMERGENCY MEDICINE SYMPOSIUM A PRACTICAL UPDATE FRIDAY, DECEMBER 8, :15 A.M. 4:30 P.M.

Innovations in Cardiovascular Care

THE 2018 SAN DIEGO DAY OF TRAUMA. Trauma 2020: A Glimpse into the Future of Trauma Care. November 2, 2018 Kona Kai Resort San Diego, California

UC Davis Pediatric Anesthesia Update

Current Concepts and Controversies 39th Annual Advances in Primary Care April 13, 2018

Topics in Bone Health:

University of Iowa Hospitals and Clinics Fundamental Critical Care Support (FCCS)

Preconception Care Conference

Stroke Symposium 2017

Neonatology Point-of-Care Ultrasound Course

Putting the Pieces Together

Primary Care Challenges in Pediatric Otolaryngology: A Case-Based Approach. A Continuing Medical Education Activity

2018 PITUITARY UPDATE A CME/CNE-Certified Conference

Pediatric Trauma Symposium

Cardiovascular Update Conference

CURRENT ADVANCES IN CARDIOVASCULAR CARE 2017

PHARMACOLOGY FOCUS ON SATURDAY, APRIL 25, Sixth Annual. An Evidence-Based Practice Conference for Advanced Practice Clinicians

Practical Management of Acute Stroke

Trauma and Alcoholism Brochure

7:15 a.m. 5:00 p.m. For the registration fees and the latest course info visit cedars-sinai.edu/emergencymedicinecme

Achieving Success: Mission Possible

The Indiana-ACC 20 th Annual Meeting

NavIgatIng the. Journey of. PedIatrIc. DIabetes. Closing the Gaps cary, nc SUPPORTED BY THE

Transcription:

CRR Teams Continuous Renal Replacement Therapy Course Directors John A. Kellum, MD Professor of Critical Care Medicine University of Pittsburgh School of Medicine Paul M. Palevsky, MD Chief, Renal Section, VA Pittsburgh Healthcare System Professor of Medicine University of Pittsburgh School of Medicine Kimberly A. Whiteman, RN, DNP(c) Instructor Waynesburg University Waynesburg, Pennsylvania International Course Director Claudio Ronco, MD Director Nephrology, Dialysis and Transplant Unit San Bortolo Hospital Vicenza, Italy New Location Sheraton Station Square Hotel 300 Station Square Drive Pittsburgh, Pennsylvania 15219 U.S.A. Jointly sponsored by: University of Pittsburgh School of Medicine Center for Continuing Education in the Health Sciences Department of Medicine, Renal-Electrolyte Division The Department of Nephrology, Dialysis and Transplantation San Bortolo Hospital Vicenza, Italy N o v e m b e r 9 & 1 0, 2 0 0 9

Overview Significant advances have occurred in the care of patients with acute kidney injury (AKI). Continuous renal replacement therapy (CRRT) has become standard of care for many critically ill patients with severe AKI and most major medical centers have developed the capability of providing CRRT. However, many hospitals lack the capacity and many that have it, underutilize it. The University of Pittsburgh Medical Center has one of the oldest and largest CRRT programs in the world. CRRT is managed jointly by critical care and nephrology and our model has numerous advantages for patients and providers alike. The intent of this conference is to provide an educational opportunity for both novice and experienced CRRT providers, to enrich existing expertise and to achieve a new understanding of this powerful treatment. Our ultimate goal is to improve outcomes for patients with AKI through teamwork and education. This two day course will focus on team-based CRRT through lectures and workshops. Who Should Attend Physicians (nephrologists and intensivists), nurses, pharmacists and allied health professionals. Continuing Education Credit This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the University of Pittsburgh School of Medicine and the San Bortolo Hospital Department of Nephrology, Dialysis, and Transplantation in Vicenza, Italy. The University of Pittsburgh School of Medicine is accredited by the ACCME to provide continuing medical education for physicians. The University of Pittsburgh School of Medicine designates this educational activity for a maximum of 13.25 AMA PRA Category 1 Credits. Physicians should only claim credit commensurate with the extent of their participation in the activity. Other health care professionals are awarded 1.325 continuing education units (CEUs), which are equal to 13.25 contact hours. This continuing education nursing activity has been approved for 13.25 contact hours by the UPMC Provider Unit of the PA Nurses Association, an accredited approver by the American Nurses Credentialing Center s Commission on Accreditation. To receive contact hours, the participant must attend the entire session and complete the evaluation form and sign-in sheets and return all information before leaving the course. Meeting Location The conference will be held at the Sheraton Station Square Hotel located at 300 West Station Square Drive, Pittsburgh, PA 15219. Parking Parking is on your own and not covered in the cost of conference tuition. Parking will cost approximately $16.00 for the day. You can find parking located adjacent to the Hotel and there is a parking garage located across the street from the hotel, there are four entrances located on three sides of the garage for your convenience. Lodging A block of rooms has been reserved at the special rate of $155 plus tax per night. This rate cannot be guaranteed beyond the cutoff date or beyond the block. Please call the hotel directly to make your arrangements at +1 (412) 682-6200. Please make sure to mention the CRRTeams room block for the special rate. Please make reservations prior Friday, October 9, 2009 at 5:00 PM. If you have trouble booking your room, please call +1 (412) 647-8232 or +1 (412) 647-9541. Special Needs Participation by all individuals is encouraged. Advance notification of any special needs will help us provide better service. Please notify us of your needs at least two weeks in advance of the program by calling +1 (412) 647-8232 or +1 (412) 647-9541. Visit the Center for Continuing Education in the Health Sciences Web Site Our Internet address is: http://ccehs.upmc.edu The UPMC/Center for Continuing Education in the Health Sciences invites you to visit our web location. Receive information on CME programs; earn CME credits on the Internet, and access information about our formal courses and much more. Discover who we are and how you can contact us. Please visit our web location often to get updated information on upcoming programs. 2

Conference Schedule Monday, November 9, 2009 7:00 am Registration & Continental Breakfast 7:50 am Welcome and Introduction Paul Palevsky, MD Morning Plenary (CRRT: Now and In the Future) 8:00 am AKI: What Is It? John Kellum, MD 8:25 am The History and Future of Renal Support Claudio Ronco, MD 8:50 am Renal Support: Options and Evidence Paul Palevsky, MD 9:15 am CVVH, CVVHD, CVVHDF Ashita Tolwani, MD 9:40 am Coffee Break CRRT Cases: How Do You Do It? 10:00 am Case Presentation 1 John Kellum, MD 11:00 am Case Presentation 2 Paul Palevsky, MD Expert Panel: Kimberly Whiteman, RN, DNP(c); Ashita Tolwani, MD; Geoffrey Sheinfield, MD; Stuart Goldstein, MD Noon LUNCH* Afternoon Workshops (Each workshop will repeat twice on each day; participants will cycle through each of the four workshops they have chosen. The name, date, and location of your workshops will be provided on-site) A. Starting a CRRT Program A-Z: Tips to successfully plan, start and manage a CRRT program. B. Prescribing: Practical aspects of prescribing CRRT. Participants will write orders and discuss actual cases with faculty. C. Circuits and Anticoagulation: Options for circuit anticoagulation will covered in real world settings. D. Pediatric Programs: Basic to advanced workshop for pediatric CRRT E. Billing: How to make the bill for services and how to make CRRT programs cost-effective. F. Selecting Technology: How to pick a machine. Participants will be guided through designing a product trial evaluation tool that allows for assessing the features of varied CRRT platforms. G. Bedside Management Issues: How to manage care for patients using the PACE troubleshooting method applied to common clinical problems. H. Drug Dosing Workshop: Principles of drug dosing and management for patients on various forms of RRT using practical examples. 1:30 pm Workshops A-H 3:00 pm Break 3:15 pm Workshops A-H 4:45 pm Monday Adjournment 5:00 pm Welcome Reception and Exhibits 7:00 pm Tuesday, November 10, 2009 7:30 am Continental Breakfast Morning Plenary (How To Make It Work) 8:00 am The Pittsburgh Model Meaghan Beerson, RN 8:25 am Cost of CRRT Emil Paganini, MD, FACP, FRCP 8:50 am What Can Go Wrong and How to Avoid It Paul Palevsky, MD 9:15 am What Gets In the Way? Frederick Tasota, RN, MSN, CCRN 9:40 am Coffee Break 10:15 am Fluid Management Stuart Goldstein, MD 10:40 am What Is Dose? Claudio Ronco, MD 11:05 am Expanded Indications for CRRT John Kellum, MD 11:30 am Drug Dosing in AKI/RRT Thomas Nolin, PharmD, PhD Noon LUNCH* Afternoon Workshops (Each workshop will repeat twice on each day; participants will cycle through each of the four workshops they have chosen. The name, date, and location of your workshops will be provided on-site) 1:30 pm Workshops A-H 3:00 pm Break 3:15 pm Workshops A-H 4:45 pm Conference Adjournment Schedule is subject to change. *Each day during the Lunch Break, registrants are invited to attend an Industry Sponsored educational Machine Forum session. Each session will be approximately 1 hour and you can choose to attend the session of the company of your choice. PLEASE NOTE: NO CME will be awarded for these sessions. They are optional. 3

Course Directors John A. Kellum, MD Professor of Critical Care Medicine Paul M. Palevsky, MD Professor of Medicine Chief, Renal Section, VA Pittsburgh Healthcare System Department of Medicine Kimberly A. Whiteman, RN, DNP(c) Instructor Waynesburg University Waynesburg, Pennsylvania International Course Director Claudio Ronco, MD Director Nephrology, Dialysis and Transplant Unit San Bortolo Hospital Vicenza, Italy Guest Faculty Robert L. Danner, MD Head, Infectious Diseases Section Director, Functional Genomics Facility Critical Care Medicine Department National Institutes of Health Bethesda, Maryland R. T. Noel Gibney, MB FRCP(C) Division of Critical Care Medicine University of Alberta Edmonton, Alberta, Canada Stuart Goldstein, MD Associate Professor Pediatrics, Renal Section Baylor College of Medicine Houston, Texas Emil P. Paganini, MD, FACP, FRCP Critical Care Nephrology Consulting Chesterland, Ohio Geoffrey Sheinfield, MD Assistant Professor of Medicine R Adams Cowley Shock Trauma Center University of Maryland School of Medicine Baltimore, Maryland Ashita J. Tolwani, MD, MS Associate Professor of Nephrology University of Alabama at Birmingham Birmingham, Alabama Local Course Faculty Hulya Bayir, MD Critical Care Medicine Fellow Children s Hospital of Pittsburgh of UPMC Meaghan Beerson, RN Advanced Practice Nurse Nursing Education UPMC Presbyterian Jose F. Bernardo, MD Assistant Professor of Medicine Department of Medicine Marc Cammarata Rhonda M. Gengler, RN, BSN, CCRN Supervisor, Patient Services Pediatric Intensive Care Unit Children s Hospital of Pittsburgh of UPMC Tracy Grogan, RN, Med Unit Director Transplant Intensive Care Unit UPMC Montefiore John R. Hotchkiss, MD Assistant Professor of Critical Care Medicine Michael L. Moritz, MD Division of Nephrology Department of Pediatrics Children s Hospital of Pittsburgh of UPMC Thomas Nolin, PharmD, PhD Assistant Professor Department of Pharmacy and Therapeutics University of Pittsburgh School of Pharmacy Richard Orr, MD Associate Professor Anesthesia and Critical Care Medicine Children s Hospital of Pittsburgh of UPMC Patricia A. Seddon, RN, MSN Advance Practice Nurse for Renal UPMC Presbyterian Kai Singbartl, MD Assistant Professor of Critical Care Medicine and Anesthesiology Holli F. Smith, CCRN Sr. Professional Staff Nurse Cardiothoracic Intensive Care Unit UPMC Presbyterian Frederick J. Tasota, RN, MSN, CCRN Advanced Practice Nurse Critical Care UPMC Presbyterian Mark Unruh, MD, MSc Assistant Professor of Medicine Department of Medicine All local course faculty members reside in metropolitan Pittsburgh, Pennsylvania area and have an appointment at the University of Pittsburgh School of Medicine unless otherwise specified. In accordance with Accreditation Council for Continuing Medical Education requirements on disclosure, information about relationships of presenters with commercial interests (if any) will be included in materials distributed at the time of the conference. 4

Registration Information (see Registration Form on page 6) Pre-Register All pre-registrations are due two weeks prior to the begin date of the conference. Registrations after this date cannot be guaranteed. On-line Registration accepted until November 4, 2009. Registering online is the quickest and easiest way to reserve your space at CCEHS conferences. Visit our online registration site at: https://ccehs.upmc.edu/formalcourses.jsp#2129 Click the Registration button and enter all of the requested information After registering, an electronic confirmation will be sent to the email address you provided us when you registered. Please note: Registration is not complete until you receive the confirmation letter / email for your pre-registration. If you do not receive this letter within 5-7 days of registration, please contact us at (412) 647-8232. You must bring this confirmation with you to the conference. Early Registration Rates (Accepted until October 9, 2009) Physicians: $ 325 Nurses and health care professionals: $195 Resident/Fellow: $ 100 Late Registration Rates (Accepted after October 9, 2009) Physicians: $ 425 Nurses and health care professionals: $ 295 Resident/Fellow: $ 200 Registration fee includes: Continuing education credit Registration and course materials Continental breakfast, refreshments and lunch Monday Evening Reception Registration Cancellation All cancellations must be in writing and sent to us via U.S. mail, e-mail or fax. Tuition for cancellations postmarked or date stamped before or on October 26, 2009 will be completely refunded. After October 26, 2009 a $35 administrative fee will be assessed. No refunds will be made after November 2, 2009. Conference contact for cancellation requests or registrations by mail or fax: Shauna R. Brown, Senior Conference Manager UPMC/CCEHS Iroquois Building, Suite 302 200 Lothrop Street Pittsburgh, PA 15213 +1 (412) 647-8232 or +1 (412) 647-954 Fax: +1 (412) 647-8222 For Additional Information, Contact: Shauna Brown, Senior Conference Manager Telephone: +1 (412) 647-8232 or +1 (412) 647-9541 Fax: +1 (412) 647-8222 E-mail: ccehsconfmgmt201@upmc.edu The UPMC/Center for Continuing Education in the Health Sciences reserves the right to cancel this program if sufficient registrations are not received. In the case of cancellation, the department will fully refund registration fees. However, other costs incurred by the registrant, such as airline or hotel penalties, are the responsibility of the registrant. The University of Pittsburgh, as an educational institution and as an employer, values equality of opportunity, human dignity, and racial/ethnic and cultural diversity. Accordingly, the University prohibits and will not engage in discrimination or harassment on the basis of race, color, religion, national origin, ancestry, sex, age, marital status, familial status, sexual orientation, disability, or status as a disabled veteran or a veteran of the Vietnam era. Further, the University will continue to take affirmative steps to support and advance these values consistent with the University s mission. This policy applies to admissions, employment, access to and treatment in University programs and activities. This is a commitment made by the University and is in accordance with federal, state, and/or local laws and regulations. For information on University equal opportunity and affirmative action programs and complaint/grievance procedures, please contact: William A. Savage, Assistant to the Chancellor and Director of Affirmative Action (and Title IX and 504 Coordinator), Office of Affirmative Action, 901 William Pitt Union, University of Pittsburgh, Pittsburgh, PA 15260, 412-648-7860. THERE WILL BE SPECIAL DISCOUNTS FOR TEAMS FROM THE SAME INSTITUTION!!! PLEASE CALL +1 (412) 647-8232 FOR DETAILS!!! A team consists of three people and must include at least one Physician and one Nurse. 5

Registration Form (see Registration Information on page 5) Continuous Renal Replacement Therapy: CRRTeams November 9-10, 2009 Course #2129 INSTRUCTIONS FOR COMPLETING PAPER REGISTRATION FORMS Use one form per registrant. Type or print legibly. No registration will be held or accepted without payment. Registrations will be accepted on a space availability basis. Mail or Fax Registration Form Accompanied by Payment to: UPMC /Center for Continuing Education in the Health Sciences 200 Lothrop Street Iroquois Building, Suite 302 Pittsburgh, PA 15213-2582 Fax: +1 (412) 647-8222 Return the Registration Form and Payment to CCEHS no later than 5 p.m. on November 4, 2009. COURSE REGISTRANT INFORMATION Use one form per person; if you are registering a team, please DO NOT use paper form! Please call +1 (412) 647-8232. Last five (5) digits of your Social Security Number (required for CE credit) Your name will appear on your conference name badge and within course correspondence as written in this completed form. Prefix: Dr. Mr. Mrs. Ms. Other, please indicate: First Name Last Name Suffix (Jr., Sr., etc ) MAILING AND CONTACT INFORMATION Company/Institutional Affiliation E-mail Address Your e-mail address is needed for the provision of the immediate return of confirmation letter. Street Address City State/Province ZIP Code Work Telephone ( ) Other Telephone ( ) Fax ( ) How did you hear about this conference? EARLY REGISTRATION LEVELS Early Registration Rates (Accepted until October 9, 2009) Physicians $325.00 Nurses and health care professionals $195.00 Resident/Fellow $100.00 LATE REGISTRATION LEVELS Late Registration Rates (Accepted after October 9, 2009) Physicians $425.00 Nurses and health care professionals $295.00 Resident/Fellow $200.00 Specialty Degree:* MD DO Resident PhD MPH RN Other, please indicate: THERE WILL BE SPECIAL DISCOUNTS FOR TEAMS FROM THE SAME INSTITUTION!!! PLEASE CALL +1 (412) 647-8232 FOR DETAILS!!! A team consists of three people and must include at least one Physician and one Nurse. *required continued on page 7 6

Registration Form continued from page 6 Please choose only FOUR of the EIGHT sessions and enter them into the time slot you would like to attend. Your preferred times are subject to change based on availability: Credit Card Payments (CHECK ONE) Visa MasterCard American Express Discover Credit Card No. A: Starting a CRRT Program A-Z B: Prescribing C: Circuits and Anticoagulation D: Pediatric Programs E: Billing F: Selecting Technology G: Bedside Management Issues H: Drug Dosing Workshop SPECIAL MEAL REQUESTS (If applicable, pick one) I require vegetarian lunch. I require kosher lunch. I have no special dietary requirements. TOTAL PAYMENT DUE AND ENCLOSED $ Registrations will be accepted on a space availability basis. Method of Payment The following methods of payment are acceptable for the registration fee. PICK ONE. Checks, personal or employer Make payable to UPMC Presbyterian Shadyside. Employer check included Personal check included Employer or Personal check to arrive under separate cover. If your personal or employer check is arriving under separate cover, you may send or fax in your completed registration form now, but you must complete the Credit Card Payments section below with valid credit card information in order to hold your reservation. If the check payment is not received by four weeks post course, we will charge the registration fee to the credit card number provided. There is a $25.00 returned check fee. Monday, 11/9/09: 1:30 pm: 3:15 pm: Tuesday, 11/10/09: 1:30 pm: 3:15 pm: CVD# (that s the 3-digit number on the back of the credit card after your account number) Expiration Date (Month/Year) Signature UPMC Journal Entry Transfer If you are a UPMC employee and your department will be responsible for payment, we can charge your department directly. DO NOT SUBMIT a disbursement to UPMC Accounts Payable. Complete the following: Business unit Account number Department ID number Authorized department signature Telephone number For additional information, contact: UPMC/Center for Continuing Education in the Health Sciences Telephone: +1 (412) 647-8232 or +1 (412) 647-9541 Fax: +1 (412) 647-8222 E-mail: ccehsconfmgmt201@upmc.edu 7

Center for Continuing Education in the Health Sciences 200 Lothrop Street Iroquois Building, Suite 302 Pittsburgh, PA USA 15213-2582 Nonprofit Org. U.S. Postage PAID Pittsburgh, PA Permit No. 2110 CRRTeams Continuous Renal Replacement Therapy N o v e m b e r 9 & 1 0, 2 0 0 9 P i t t s b u r g h, P e n n s y l v a n i a U. S. A.