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Intensive diagnostic interviewing board review course - CME

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TUITION<br />

Optional Day Fees<br />

Physicians: $250<br />

Non-Physicians, Residents* and Fellows in<br />

Training*: $135<br />

Two-Day Fees<br />

Physicians: $995<br />

Non-Physicians, Residents* and Fellows in<br />

Training*: $495<br />

ACCREDITATION<br />

Harvard Medical School is accredited by the<br />

Accreditation Council for Continuing Medical<br />

Education (AC<strong>CME</strong>) to provide continuing<br />

medical education for physicians. Harvard<br />

Medical School designates the Two-Day<br />

Course for a maximum of 15 category 1 credits,<br />

the Optional Day Course for a maximum<br />

of 6.5 category 1 credits, and the Complete<br />

Three-Day Course for a maximum of 21.5<br />

category 1 credits toward the AMA<br />

Physician's Recognition Award. Physicians<br />

should only claim credit commensurate with<br />

the extent of their participation in the activity.<br />

Psychologists - The Massachusetts Mental<br />

Health Center is approved by the American<br />

Psychological Association to sponsor continuing<br />

Education for psychologists. Massachusetts<br />

Mental Health Center maintains responsibility<br />

for the program and its content. The<br />

Two-Day Course offers 15 credit hours, the<br />

Optional Day Course offers 6.5 credit hours,<br />

and the Complete Three-Day Course offers<br />

21.5 credit hours.<br />

Counselors - Massachusetts Mental Health<br />

FACULTY (Partial List)<br />

Andrew Aldridge, M.D., Clinical Instructor<br />

of Psychiatry, Harvard Medical School.<br />

William Appleton, M.D., Assistant Clinical<br />

Professor of Psychiatry, Harvard Medical<br />

School.<br />

James Beck, M.D., Ph.D. Professor of<br />

Psychiatry, Harvard Medical School.<br />

Carla Canuso, M.D., Instructor in<br />

Psychiatry, Harvard Medical School.<br />

David E. Creasey, M.D., Clinical Instructor<br />

in Psychiatry, Harvard Medical School.<br />

John A. Fromson, M.D., Assistant Clinical<br />

Professor of Psychiatry, Harvard Medical<br />

School; Chairman, Department of Psychiatry,<br />

MetroWest Medical Center.<br />

Robert M. Goisman, M.D., Associate<br />

Professor of Psychiatry, Harvard Medical<br />

School; Director of Medical Student<br />

Education at Mass. Mental Health Center.<br />

Thomas G. Gutheil, M.D., Professor of<br />

Psychiatry, Harvard Medical School; Co-<br />

Director, Program in Psychiatry and the<br />

Law, Mass. Mental Health Center.<br />

Gordon Harper, M.D., Associate Professor<br />

of Psychiatry, Harvard Medical School.<br />

Center is approved by the National Board of<br />

Certified Counselors to offer continuing education<br />

to participants. The Two-Day Course<br />

meets the criteria for 15 credit hours, the<br />

Optional Day Course meets the criteria for<br />

6.5 credit hours, and the Complete Three-<br />

Day Course meets the criteria for 21.5 credit<br />

hours.<br />

Nurses - Massachusetts Mental Health<br />

Center is approved by the Arizona State<br />

Nurses Association to offer continuing education<br />

credits to participants. The Two-Day<br />

Course meets the criteria for 18 contact<br />

hours, the Optional Day Course meets the<br />

criteria for 7.8 contact hours, and the<br />

Complete Three-Day Course meets the criteria<br />

for 25.8 contact hours.<br />

REFUND POLICY<br />

A handling fee of $60 is deducted for cancellation.<br />

Refund requests must be received by<br />

mail or fax one week prior to the <strong>course</strong>. No<br />

refunds will be made thereafter.<br />

Please Note: Program changes/substitutions<br />

may be made without notice.<br />

REGISTRATION<br />

All foreign payments must be made by a draft<br />

on a United States bank, or by Visa or<br />

MasterCard. If paying by check, please make<br />

it payable to Harvard Medical School and mail<br />

with the completed registration form to:<br />

Harvard Medical School, Department of<br />

Continuing Education, P.O. Box 825,<br />

Boston, MA 02117-0825. If paying by credit<br />

card, please fax the completed registration<br />

form to (617) 384-8686, register online at<br />

www.cme.hms.harvard.edu, or mail it to the<br />

above address. Telephone registrations are<br />

not accepted. Inquiries should be directed to<br />

the above address, made by phone: (617)<br />

384-8600, Monday - Friday, 10 a.m. to 4 p.m.<br />

(EST), or by e-mail: hms-cme@hms.harvard<br />

.edu. Upon receipt of registration a confirmation<br />

will be mailed to the address listed on the form.<br />

ACCOMMODATIONS<br />

Hotel rooms in Boston are limited. You are<br />

urgd to make your reservations early. A limited<br />

number of rooms have been reserved at<br />

the Courtyard by Marriott, Brookline for the<br />

sessions. Call 617-734-1393 for reservations.<br />

Please specify that you are with the Harvard<br />

Medical School <strong>Intensive</strong> Diagnostic<br />

Interviewing Course. For additional housing<br />

assistance, call Boston Reservation at (617)<br />

332-4199.<br />

COURSE LOCATION<br />

The July sessions will be held at Courtyard<br />

by Marriott, Brookline, 40 Webster Street,<br />

Brookline, MA 02446 (617-734-1393). For<br />

location information for the other <strong>course</strong><br />

dates, please contact the Continuing<br />

Educaion Program at 617-998-5028.<br />

TRAVEL<br />

For information on reduced airfare, call<br />

Harvard Medical School, Department of<br />

Continuing Education at 617-384-8600,<br />

Monday-Friday, 10 a.m. to 4 p.m. (EST).<br />

✂--------------------------------------------------------------------------------------------------------------------------------------<br />

INTENSIVE DIAGNOSTIC INTERVIEWING<br />

Please indicate your first choice<br />

by inserting the number 1 into the<br />

box adjacent to the seminar date.<br />

If possible, rank subsequent<br />

choices with the numbers 2, 3,<br />

etc.<br />

An Optional Day Course<br />

Class #272564<br />

❐ December 6, 2006<br />

❐ March 14, 2007<br />

❐ March 28, 2007<br />

❐ April 11, 2007<br />

A Two-Day Course<br />

Class #272564<br />

❐ December 7-8, 2006<br />

❐ March 15-16, 2007<br />

❐ March 29-30, 2007<br />

❐ April 12-13, 2007<br />

INTENSIVE DIAGNOSTIC INTERVIEWING<br />

Visit Harvard Medical School, Department of Continuing Education online at www.cme.hms.harvard.edu<br />

J. Allan Hobson, M.D., Professor of<br />

Psychiatry, Harvard Medical School.<br />

Sheryl Hunter, M.D., Instructor in<br />

Psychiatry, Harvard Medical School.<br />

Marvin Krims, M.D., Lecturer on<br />

Psychiatry, Harvard Medical School.<br />

Richard Marcus, M.D., Lecturer on<br />

Psychiatry, Harvard Medical School;<br />

Medical Director, Child & Adolescent<br />

Service, Fuller Hospital.<br />

Matthew Robinson, Ph.D., Clinical<br />

Instructor in Psychiatry, Harvard Medical<br />

School.<br />

Carl Salzman, M.D., Professor of<br />

Psychiatry, Harvard Medical School;<br />

Director of Psychopharmacology,<br />

Massachusetts Mental Health Center.<br />

Graham Spruiell, M.D., Clinical Instructor<br />

in Psychiatry, Harvard Medical School.<br />

Russell G. Vasile, M.D., Associate<br />

Professor of Psychiatry, Harvard Medical<br />

School; Director of the Affective Disorders<br />

Consultation Service at Beth Israel<br />

Deaconess Medical Center.<br />

Suzanna Zimmet, M.D., Assistant<br />

Professor of Psychiatry, Harvard Medical<br />

School.<br />

OPTIONAL DAY TUITION FEES<br />

Physicians: $250 (USD)<br />

Residents* and Fellows in Training*: $135 (USD)<br />

Upcoming Programs<br />

FALL SEMINARS<br />

Esalen Institute, Big Sur, Calif.<br />

• September 25-29, 2006<br />

• October 13-15, 2006<br />

• October 20-22, 2006<br />

• October 23-27, 2006<br />

• October 27-29, 2006<br />

• November 10-12, 2006<br />

Liability, Boston, MA<br />

• December 1-2, 2006<br />

WINTER & SPRING SEMINARS<br />

Ocean Reef Club, Key Largo, FL.<br />

• February 26-March 2, 2007<br />

• March 5-9, 2007<br />

Esalen Institute, Big Sur, Calif.<br />

Week Long Seminars:<br />

• March 4-9, 2007<br />

• May 7-11, 2007<br />

• June 18-22, 2007<br />

• June 25-29, 2007<br />

Weekend Seminars:<br />

• January 29-February 2, 2007<br />

• March 16-18, 2007<br />

• March 30-April 1, 2007<br />

• April 13-15, 2007<br />

• May 4-6, 2007<br />

TWO-DAY TUITION FEES<br />

Physicians: $995 (USD)<br />

Residents* and Fellows in Training*: $495 (USD)<br />

*A letter of verification from Department Chair must accompany registration form for a reduced fee.<br />

Please Print Clearly<br />

Full Name ___________________________________________________________ Degree ___________________<br />

Last First Middle Initial<br />

Mailing Address ________________________________________________________________________________<br />

Street City State Zip Code<br />

Daytime Phone (____)__________________________________ Fax Number (____)_________________________<br />

E-Mail Address _________________________________________________________________________________<br />

❑ Please check if you want to be excluded from receiving email notices of future<br />

Harvard Medical School, Department of Continuing Education programs.<br />

Professional School Attended ________________________________________ Year of Graduation _____________<br />

Profession _____________________________________________________________________________________<br />

Principal Specialty ______________________________________________________ Board Certified: Yes ❏ No ❏<br />

Organization Affiliation ___________________________________________________________________________<br />

Form of Payment (please check one):<br />

❏ Check is enclosed: Please make your check payable to Harvard Medical School and mail it with this registration<br />

form to:<br />

Harvard Medical School, Department of Continuing Education, P.O. Box 825, Boston, MA 02117-0825<br />

❏ Bill my credit card: ❏ VISA ❏ MASTERCARD ______- ______-______- ______<br />

Credit Card Number<br />

Tuition Fee $ ______ ____________ __________________________ ___________________________<br />

Expiration Date Print Name As It Appears on Card Signature<br />

Registrations paid by credit card can be faxed to (617) 384-8686, or mailed to the above listed address.<br />

Source Code: A X Z

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