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FAMedugf3qTCaz4KGAZvFJ6n2rj4CcJ3NzV8tfbQGrWWpEaGeTJzXbimI

Musculoskeletal Ultrasound in Hemophilia Application for Funding Assistance

The MSKUS Funding Assistance Program for Continuing Medical Education, Musculoskeletal Ultrasound in Hemophilia training course. This course is hosted and facilitated at the University of California San Diego, Hemophilia & Thrombosis Treatment Center. Educational funding assistance is a need based support program intended to provide one-time financial support for participation of hemophilia providers such as physician, physician assistant, nurse practitioner, nurse, physical therapist, trainee(s) (Fellow, Resident and medical student) and other providers directly involved in the care of hemophilia and other bleeding disorder patients. The program is geared towards teaching hemophilia providers hemophilic joint disease to recognize joint bleeding synovial hypertrophy and synovitis, cartilage degradation, osteochondral lesions and other structural joint abnormalities. The program also introduces global joint health assessment by using semi-quantitative algorithms (Martinoli C, et al. TH 2013) and quantitative measurement tools currently developed by Drs. von Drygalski and Moore (Joint Assessment and Damage Examination (JADE)Guidelines.

1. Date of Application:

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M-D-Y

Organization Information

2. Name of Organization

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3. Street address

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As Required
4. City, State, Providence, Mail/Zip code...ect

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5. Country

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6. Organization Phone Number

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7. Organization Fax Number

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8. Company/Organization Web Site

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Applicant Information

By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

9. Title

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Title Other

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10. First Name

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11. Last Name

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Suffix

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Suffix other

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12. Job Title

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13. Company Name

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14. Work Phone

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15. Email Address

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16. Mailing Address 1

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17. Mailing Address 2:

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18. City:

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19. State/Province

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20. Postal Code:

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21. Country:

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22. What is your motivation to take the MSKUS course?

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23. Please describe your current role

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24. Please provide a brief summary of the benefit this course will have on your current role within the Hemophilia community

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25. Describe any financial barriers and needs required to attend the MSKUS training course?

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26. Funds are being requested for (check all that apply)

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Registration fee

Travel fees

Accommodation/Lodging

Other, please specify

Other, Please specify

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27. Please select your Provider Type/Specialty

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Other, please specify

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28. Please select your current practice type
(check all that apply)

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Private Practice

Hemophilia Treatment Center

Hospital

University Hospital/Academic Center

Other, please specify

Other, Please specify

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29. What barriers prevent your participation in continuing education opportunities? (check all that apply)

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Travel fees

Time commitment

Registration fees

Visa

Language difficulties

Travel distance

Other, please specify

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30. How many patients with Hemophilia do you see annually?

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0-10

11-50

51-100

>100

Other, please specify

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Other, please specify

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31. Are you currently using Ultrasound for joint evaluations in patients with Hemophilia? If your answer is yes, please specify how many times per month.

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Yes

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If your answer is yes, please specify how many times per month.

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0-5

6-10

>10

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32. Do you have access to an Ultrasound machine? If your answer is no, please answer question number 33.

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Yes

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33. If your answer is no to question number 32, do you have plans to get access to an ultrasound machine after the MSKUS training course? If yes, please explain how.

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34. How did you learn about continuing education on MSKUS opportunities with the UC School of Medicine?
(check all that apply)

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Blogs

Conferences

Colleagues

Emails

Employer

Professional Organizations

RSS feeds

Vendors

Website

Industry Representative

Other, please specify

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35. What have we not asked you and your organization about what you feel is important?

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Please send any written response answers on the letterhead of your institution if you require more space for your responses to mxzepeda@ucsd.edu. If you have any questions, please contact Marlene Zepeda, Hemophilia Program Specialist at 858-249-0341 or mxzepeda@ucsd.edu.

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