OSHRM/SOHA Fall Conference September 29, 2017 The Blackwell Inn Columbus, Ohio

OSHRM/SOHA Fall Conference September 29, 2017 The Blackwell Inn Columbus, Ohio

The Event The Ohio Society of Healthcare Risk Manager s (OSHRM) mission is to promote risk management, which protects human and financial assets, in a manner consistent with compassion, quality and cost-effective health care. The purpose of the Society of Ohio Healthcare Attorneys (SOHA) is to advance the field of health care law by providing a forum for the exchange of information among attorneys serving Ohio health care providers, presenting relevant educational programs, monitoring emerging legal issues and developing case law pertaining to Ohio health care. You are invited to contribute to this important event by submitting a proposal for an educational presentation. Presentations should be designed for about 55 minutes of presentation time. Themes Proposals can be submitted on any topic. Use this list as a guide for proposal development: Accreditation & Performance Improvement Behavioral Health Compliance Data and Technology Governance & Leadership Legal Climate/Risk Management Opioid Crisis Public Reporting/Transparency Quality & Patient Safety Regulatory Updates Risk Management Selection Submissions will be reviewed by the OSHRM/SOHA Education Committee. Criteria for selection include: Relation to hospital staff, physician or trustee educational needs Currency of content Clarity of proposal Credentials of Speaker - Platform Skills - Demonstrated command of subject Congruence with proposal format Completeness of submission Conformance with deadlines Deadline Proposals must be received by June 30, 2017. Notification of presenters will be around mid-july. Submission Proposals should be e-mailed or faxed to: Linda Oman, CPHRM President-Elect, OSHRM Fax: 419-734-4101 loman@magruderhospital.com Please make sure to submit your proposal ONLY ONCE. 2

OSHRM/SOHA Fall 2017 Conference Presentation Proposal Submission Form 2017 Program length 55 minutes Please complete each information element. Forms with missing or incomplete information will not be considered. Session Title (12 words or less) Program Overview Description (50 words or less). Describe what attendees will gain from this presentation. Learning Objectives Describe what participants will be able to do as a result of participation. Provide three objectives. 1. 2. 3. Note: We can acknowledge no more than 3 speakers. Please limit presentation to 3 or less speakers. All information on form must be completed for each speaker for Continuing Education approvals. If it is not, your presentation will not be considered. Signature from each speaker is a MUST! 3

Speaker #1 Name Highest Degree earned (MD, Ed.D, MA BS etc. Degree Conferred in Specialty Current Job Title Organization Address City State Zip code E-mail address Phone Fax CE Accreditation standards require speakers to disclose financial interests related to presentations. Please check the statement that applies: I have no real or perceived conflicts of interest related to this presentation I have the following relationship that may be considered a conflict of interest Please describe relationship: If you are a FACULTY or PRESENTER describe your expertise on this topic. Please Complete! Type Bio Here (please do not send CV, we need a brief bio for intro purposes) Please Complete! Speaker #1 Signature Date Signature required for CE accreditation. Proposals without signatures will not be considered. 4

Speaker #2 Name Highest Degree earned (MD, Ed.D, MA BS etc. Degree Conferred in Specialty Current Job Title Organization Address City State Zip code E-mail address Phone Fax CE Accreditation standards require speakers to disclose financial interests related to presentations. Please check the statement that applies: I have no real or perceived conflicts of interest related to this presentation I have the following relationship that may be considered a conflict of interest Please describe relationship: If you are a FACULTY or PRESENTER describe your expertise on this topic. Please Complete! Type Bio Here (please do not send CV, we need a brief bio for intro purposes) Please Complete! Speaker #2 Signature Date Signature required for CE accreditation. Proposals without signatures will not be considered. 5

Speaker #3 Name Highest Degree earned (MD, Ed.D, MA BS etc. Degree Conferred in Specialty Current Job Title Organization Address City State Zip code E-mail address Phone Fax CE Accreditation standards require speakers to disclose financial interests related to presentations. Please check the statement that applies: I have no real or perceived conflicts of interest related to this presentation I have the following relationship that may be considered a conflict of interest Please describe relationship: If you are a FACULTY or PRESENTER describe your expertise on this topic. Please Complete! Type Bio Here (please do not send CV, we need a brief bio for intro purposes) Please Complete! Speaker #3 Signature Date Signature required for CE accreditation. Proposals without signatures will not be considered. 6

Return by June 30, 2017 to: Linda Oman, CPHRM President-Elect, OSHRM loman@magruderhospital.com Fax: 419-734-4101 7