Maine Naturopathic Physician Continuing Education

• Review the anatomical and functional causes of  leg length discrepancies
• Review the kinematics and kinetics of leg length discrepancies during the gait cycle.
• View and discuss several new case studies looking at anatomical leg length discrepancies and the impact of compensations to accommodate the fixed changes. 
• Discuss examination procedures to facilitate understanding of the pathomechanics resulting from a leg length discrepancy. 
• Propose intrinsic and extrinsic remedies for the gait abnormalities seen.

• Provide an overview of orthotic therapy
• Review orthotic casting processes and contrast differences and potential pitfalls in them
• Discuss common problems arising from orthotic prescription (blisters, pain during use, pressure spots, etc)
• Propose mechanisms for why problems occur biomechanically
• Present remedies for common problems that arise

• Discuss retraining CNS sensory and motor patterns
• Present several key concepts in visual gait analysis
• Introduce lesser known anatomical points of interest in the sacroiliac joint
• Discuss some rehabilitation strategies for the sacroiliac joint

• Discuss retraining CNS sensory and motor patterns
• Present several key concepts in visual gait analysis
• Introduce lesser known anatomical points of interest in the sacroiliac joint
• Discuss some rehabilitation strategies for the sacroiliac joint
• Discuss the ideal kinetics and kinematics of the walking gait cycle
• Present the normal lower extremity parameters/ontogeny surrounding the requisites for gait
• Explore the impact of lower extremity torsions on foot progression angle
• Highlight the differences between tibial and femoral leg length discrepancies
• View video examples of different aspects of gait
• Review the mechanics of the bridge exercise
• Discuss the current indexed literature surrounding the bridge exercise
• Describe potential pitfalls in performing and prescribing the bridge exercise
• Point out the differences of maintaining a "neutral spine" versus an increased or decreased lumbar lordosis
• Identify potential ways to correct faulty mechanics and optimize performance of the bridge exercise
• describe a new, novel test to diagnose gluteus medius tears
• explain the various functions of the gluteus maximus and medius
• explore the effects of a resistance band around the knees on the gluteus maximus, quadricep and valgus angles on the knees during a back barbell squat
• contrast gluteus medius resistance and rehabilitation exercises with respect to maximal recruitment
• discuss electromyographic activity in the gluteus medius, gluteus maximus, biceps femoris, vastus lateralis, vastus medialis and rectus femoris during the Monopodal Squat, Forward Lunge and Lateral Step-Up exercises

• Discuss the ideal kinetics and kinematics of the walking gait cycle
• Present the normal lower extremity parameters/ontogeny surrounding the requisites for gait
• Explore the impact of lower extremity torsions on foot progression angle
• Highlight the differences between tibial and femoral leg length discrepancies
• View video examples of different aspects of gait

• Review the mechanics of the bridge exercise
• Discuss the current indexed literature surrounding the bridge exercise
• Describe potential pitfalls in performing and prescribing the bridge exercise
• Point out the differences of maintaining a "neutral spine" versus an increased or decreased lumbar lordosis
• Identify potential ways to correct faulty mechanics and optimize performance of the bridge exercise

• describe a new, novel test to diagnose gluteus medius tears
• explain the various functions of the gluteus maximus and medius
• explore the effects of a resistance band around the knees on the gluteus maximus, quadricep and valgus angles on the knees during a back barbell squat
• contrast gluteus medius resistance and rehabilitation exercises with respect to maximal recruitment
• discuss electromyographic activity in the gluteus medius, gluteus maximus, biceps femoris, vastus lateralis, vastus medialis and rectus femoris during the Monopodal Squat, Forward Lunge and Lateral Step-Up exercises.

• Review ideal walking gait biomechanics
• Discuss the current indexed literature surrounding sandals and open back footwear relative to musculoskeletal symptoms
• Describe pathomechanics associated with wearing flip flops and open back footwear
• Contrast the ideal gait cycle with the gait cycle while wearing flip flops, sandals and open back footwear
• Identify potential ways to correct faulty mechanics associated with wearing open back footwear

• Review ideal walking gait biomechanics
• Discuss the indexed literature surrounding movement patterns, gait remodeling and therapeutic uses of a split treadmill
• Rehab gait movement patterns
• Develop a deeper understanding of arm swing, leg swing, and interlimb timing and coordination.

• Identify ideal walking gait biomechanics
• Discuss the indexed literature surrounding movement patterns, gait impairments and compensations.
• Analyze arm swing, leg swing, and interlimb timing and coordination.
• Interpret local foot biomechanics and compensations.

• Review the gait cycle and gait cycle biomechanics
• View and discuss case studies of gait pathologies
• Assess actions of the lower kinetic chain during gait
• Predict pathomechanics that will arise from gait abnormalities presented
• Propose remedies and rehabilitation strategies for the gait abnormalities seen

Hour 1

• Identify some common gait abnormalities seen in gait analysis and develop mental strategies in evaluating the 3 cardinal planes of motion and potential failures in the loading of these planes.
• Categorize the Fast and Slow phases of an imbalance asymmetrical gait and define rehabilitation strategies to remedy the gait pathology.
• Develop a conceptual overview of how step length and stride length change in a limping gait.
• Breakdown portions of the gait cycle into its component parts, including compensation patterns
• Conceptualize the gait changes oriented around a hallux (great toe) amputation and learn to predict gait compensations off of a fixed anatomic anomaly.
• Describe arm swing and how it plays out in gait, particularly asymmetrical, and develop some treatment concepts in addressing this asymmetry.

Hour 2

• Discuss the critical function of the deep neck flexors and transverse abdominus, and how they related to gait, especially the running athlete.
• Identify the 3 compartments of the thoracolumbar fascia and translate them into gait concepts and treatment concepts.
• Develop treatment concepts in addressing this asymmetry and define in-phase and out-of-phase arm and leg swing assimilation
• Discuss on a surface level the concepts of speed in gait, and how to adjust the speed of one's gait to break down gait components that might lead to better treatment directions.
• Describe central pattern generators and relate to arm swing on a neurologic level.
• Recognize some common gait abnormalities seen in gait analysis such as arm swing, step length, the cross over gait, and develop mental strategies in evaluating the 3 cardinal planes of motion and potential failures in the loading of these planes when it comes to these gait parameters.

• Present the etiology of blister and callus formation
• Review the gait cycle and the biomechanical events relevant to callus formation
• Review pronation and supination motions of the foot and how they relate to low and high gear push off
• Review the 3 rockers and how they can relate to callus formation
• Discuss the more common callus patterns in feet
• Describe the foot pathomechanics that lead to callus formation

• Discuss the anatomy of the tibialis posterior muscle
• Emphasize the importance of blood supply and the presence of watershed areas leading to tendon pathoanatomy
• Present the biomechanics associated with this muscles normal activity vs dysfunction
• Show clinical examples of posterior tibial tendon dysfunction
• Discuss orthotic intervention and exercises that are useful in remediation of posterior tibial tendon dysfunction

• Discuss the concept of Gender as it relates to society, language and culture
• Identify Gender roles in Western Society
• Recognize innate gender traits in males and females
• Summarize socially imposed gender traits

• This includes all courses with the educational objectives listed from Boundary Training 101 through Boundary Training 112

• Identify aspects of male and female psychological development
• Relate basic concepts of Gender and Power
• List female and male leadership factors
• Discuss gender and the Doctor/Patient relationship
• Identify the ways which gender affects the Doctor/Patient relationship

• Describe what accounts for the differences, in practice style and patient care, between males and females healthcare providers
• Define differing sexualities in western culture
• Review sexuality as it relates to the Doctor/Patient relationship
• Identify misconceptions in personal definitions of male, female, power and sexuality
• Recognize when Power is misused and becomes a threat

• Define Touch as it relates to perception, gender and culture
• Discuss the giving up of power as it relates to patients and touch
• Recognize the perception, intention, and uses of touch
• Perform an analysis of individual conceptions of gender and sexuality

• Perform an exercise to identify personal concepts of touch
• Create practical applications for healthcare practitioners with regard to gender, touch, and sexuality
• Define sexual misconduct
• Recognize the difference between sexual misconduct and sexual harassment
• Critique different models of misconduct

• Describe how misconduct occurs
• Distinguish between different types of offenders
• Give examples of case studies in sexual misconduct
• Identify common fears and misconceptions of sexual misconduct
• Specify important concepts of treated a patient who has a history of abuse

• Define professional boundaries and relate the issue of consent
• Describe the three types of power, the three patterns of power, and how power is used
• Discuss the differences between adherence vs. compliance and transference vs. countertransference
• Identify anatomical risk levels for touch

• Develop safe touch guidelines
• Create a set of office based interventions and patient based interventions in the development of safe practice strategies
• Define educational interventions for safe practice strategies
• Define the basics of the supervision for a safe practice strategy

• Develop and outline for safe practice analysis
• Perform a risk factor analysis
• Execute a healthcare provider questionnaire
• Create a staff evaluation to implement at the office

• Develop and implement a buddy/supervisor evaluation of the healthcare provider and staff
• Develop and implement a patient evaluation of the healthcare provider and staff
• Create a system of analysis for the buddy/supervisor, healthcare provider, staff and patient evaluations

• Develop a plan for change based on the risk factor analysis (RFA) and practice evaluation questionnaires
• Identify areas of improvement for touch, consent, communication and respect
• Address concerns raised by staff and patients
• Discuss ways to defuse attraction

• Develop guidelines of dealing with a patient who is attracted to you
• Develop guidelines of dealing with feeling an attraction
• Discuss the six factors for a safe practice
• Describe the new partnership between healthcare providers and patients

• Identify the purpose of professional boundaries
• Differentiate between boundary violations and boundary crossings
• Identify the various factors related to dual relationships
• Identify issues related to bartering, gifts and boundaries

• Recognize the challenges of social networking and boundaries
• Evaluate issues specific to boundaries
• Clarify guidelines for maintaining professional boundaries
• Reflect on the maintenance of professional boundaries

• Describe the biomechanics of rotation of a thoracic ring at the levels T1-T7.
• Describe the biomechanics of the Cervical spine, Thoracic spine, ribs, clavicle and manubrium with elevation of the right or left shoulder.
• Describe the biomechanics of flexion and extension at the Costotransverse joint at T9.
• Describe the differences in motion of the mobile segments between T3 -T7 with side flexion occurring first in the Thoracic spine.

• This contains all courses with the educational objectives listed from Breathing Essentials 201 through Breathing Essentials 207

• Describe the physiology of breathing and how altered pH can affect the body.
• Describe two functions of the diaphragm.
• Identify limited chest expansion and Bradcliff angles and ski jumps
• Identify limited lateral costal breathing and how to facilitate normal lateral costal breathing

• Describe how altered breathing patterns can alter pH and how this can affect the body.
• Describe the autonomic nervous system and function.
• Name three physiological consequences of respiratory alkalosis.
• Describe suboptimal breathing patterns and their effect on the cervical spine and chronic pain.

• Name and describe the different types of sleep apnea.
• Describe the three levels of Apnea-hypopnea index AHI.
• List five symptoms of sleep apnea.
• List two treatments for sleep apnea.

• Describe the physiological response of aerobic exercise on the respiratory system.
• Describe the effect of running on the viscera and the diaphragm.
• Describe the response to inspiratory muscle fatigue on the body.
• List one device than may increase endurance of the respiratory muscles.

• Describe the anatomical structure of the diaphragm including innervation and blood supply.
• List four causes that may damage the innervation to the diaphragm and effect normal function.
• Describe the factors involved in Intensive Care Unit Acquired Weakness.
• Be able to describe the pros and cons of early mobilization in the ICU.

• Discuss the place cannabis products have in healthcare.
• Recall the historic relevance cannabidiol (CBD) has in patient care.
• Analyze which manual therapeutic modalities best compliment CBD usage and apply it to their practice.
• Discuss federal and state laws that apply to CBD use within their practice.
• Assess and differentiate between different CBD products to find that best suits their personal/ professional use.

• Outline the most commonly encountered neurological complaints of pregnancy that a D.C. might encounter in practice
• Differentiate between similar complaints to establish best course of care
• Modify normal practices, techniques and methods to accommodate for the biomechanical changes of the pregnancy patient
• Integrate other palliative therapies to relieve these complaints
• Analyze and adjust according to the complaint and concomitant exam findings

• This contains all courses with the educational objectives listed from Chiropractic and Pregnancy 201 through Chiropractic and Pregnancy 207

• Outline eight commonly encountered complaints of pregnancy that a DC might encounter in practice
• Differentiate between similar complaints to establish best course of care
• Understand the various causes of each complaint and how to address these causes
• Integrate other palliative therapies to relieve these complaints
• Analyze and adjust according to the complaint and concomitant exam findings

• Outline the most common herbal and homeopathic remedies that may be useful to a DC who cares for pregnant patients
• Differentiate between helpful remedies and those contraindicated for use during pregnancy
• How and when to successfully integrate these palliative therapies to relieve common complaints of pregnancy
• Recognize the basics of homeopathy, why and how it works, how to administer remedies and proper use and storage of remedies
• Generalize the use and need for these remedies to accommodate the special needs and concerns of the pregnancy patient

• Outline necessary dietary requirements for the mother to be
• Differentiate between safe and unsafe exercises that can be recommended to the expectant mother
• Give examples of safe exercise practices to the pregnant patient
• Identify the normal and customary weight gain during a healthy pregnancy
• Offer dietary recommendations and healthy food choices to the pregnant patient

• Identify the most common birth trauma(s) to a newborn
• Assess the biomechanics of the pregnant pelvis
• Recognize how certain maternal pelvic misalignments can lead to increased incidence of various birth traumas
• Modify adjustive techniques and methods to better care for the pregnant patient
• Reduce the prevalence of certain birth traumas due to distortions and misalignments in the maternal pelvis

• Identify the most common medical tests and procedures performed on pregnant and laboring women
• Recognize the risks of these tests and procedures
• Assess the benefits of these tests and procedures
• Effectively explain these risks and benefits to the pregnant patient
• Assist in the preparation of a well thought out and defined birth plan for the pregnant patient

• Outline commonly encountered misalignment and/or subluxation patterns that present with a breech presentation
• Outline commonly encountered misalignment and/or subluxation patterns that present with various common complaints of pregnancy
• Identify the various causes of a breech presentation and how to address these causes
• Integrate or eliminate other palliative therapies to aid in the reversal of a breech presentation and common complaints of pregnancy
• Analyze and adjust according to the patient history and concomitant exam findings

• Outline commonly encountered misalignment and/or subluxation patterns that present with a breech presentation
• Outline commonly encountered misalignment and/or subluxation patterns that present with various common complaints of pregnancy
• Outline commonly encountered misalignment and/or subluxation patterns that present with a twin breech presentation
• Integrate or eliminate other palliative therapies to aid in the reversal of a breech presentation and common complaints of pregnancy
• Analyze and adjust according to the patient history and concomitant exam findings

• This contains all courses with the educational objectives listed from Chiropractic and Pregnancy 208 through Chiropractic and Pregnancy 212

• Outline commonly encountered misalignment and/or subluxation patterns that present with a breech presentation
• Identify the correlation between a misaligned pubic bone and an occiput posterior presentation
• Draw a parallel between a superior pubic bone misalignment and round ligament pain
• Develop a pregnancy care plan based on exam findings and presenting complaints

• Outline commonly encountered postpartum complaints that a chiropractor might encounter in practice
• Understand the various chiropractic causes of each complaint and how to address these causes.
• Integrate other palliative therapies to relieve these complaints if applicable
• Analyze and adjust according to the complaint and concomitant exam findings
• Modify adjustive techniques and methods to better care for the postpartum patient

Hour 1

• Examine all reported cases of serious adverse events in infants and children receiving manual therapies from chiropractors as well as practitioners from other disciplines
• Outline the connection between pregnancy-related pelvic girdle pain and biomechanical changes during pregnancy
• Review differential diagnostic consideration for the important causes of back pain in children and adolescents
• Analyze the design and results of a pragmatic study on chiropractic care for infant colic
• Justify the chiropractic management of pregnant patients with low back or pelvic pain

Hour 2

• Outline the state of the literature on the treatment of childhood respiratory conditions with manual therapy
• Evaluate the effect of supplementing various combinations and types of micronutrients on the course and outcomes of pregnancy
• Examine whether a multimodal approach of musculoskeletal and obstetric management (MOM) was superior to standard obstetric care to relieve pain and reduce impairment and disability in the antepartum period
• Assess the peer-reviewed literature on the effectiveness of physical therapy interventions in treating lumbopelvic pain during pregnancy
• Summarize the results of a systematic review evaluating the evidence for the use of spinal manipulative therapy for pediatric conditions

• Appraise the literature pertaining to the safety of acupuncture for pregnant women
• Summarize consensus-based recommendations regarding best practices for the chiropractic care of children
• Explore the association between exercise levels and types pre-pregnancy and pelvic girdle pain during pregnancy in nulliparous women
• Assess alterations in pelvic floor function in pregnant women secondary to spinal manipulation
• Compare the effectiveness of Kinesio taping combined with exercise on abdominal recovery in women post-caesarean section compared with exercise alone

• Identify safety measures involved with essential oils
• Understand the various possible reactions if safety measures are not followed properly 
• Outline common methods of applications of various essential oils
• Identify the essential oils commonly used during pregnancy and labor and the uses of each
• Further identify essential oils that are contraindicated during pregnancy and labor

• Discuss the role of chiropractic manipulation and the evidence surrounding reduced back pain in pregnant women.
• Discuss the role of chiropractic manipulation and the evidence surrounding musculoskeletal conditions related to pregnancy
• Describe the somatovisceral reflex
• Review options for conservative pain management for musculoskeletal conditions related to pregnancy
• Interpret evidence-based data for safety of spinal manipulation of pregnant women.
• Describe presentation of musculoskeletal conditions seen in postpartum patients
• Perform evaluation of musculoskeletal conditions seen in postpartum patients
• Discuss treatment options for musculoskeletal conditions seen in postpartum patients
• Formulate a nutritional plan for women

• Evaluate the evidence for chiropractic care for pregnancy-related low back pain and pelvic girdle pain
• Assess the effectiveness of treatments within the chiropractic scope of practice for low back pain, pelvic girdle pain, or combination pain during the postpartum period
• Summarize best-practice recommendations for chiropractic care of pregnant and postpartum patients

• Summarize the three stages of pregnancy.
• Recognize common pregnancy abbreviations.
• List the benefits of exercise during pregnancy.
• Explain how the hormones, relaxin and hCG, can impact physical activity.
• Design a subjective and history taking examination for a pregnant patient.
• Complete a physical examination on a pregnant patient including common complaints such as pelvic girdle pain and low back pain.
• Assess patient positions to ensure comfort and safety during physical assessments and/or rehabilitation.
• Recognize when to refer a pregnant patient to another specialty for evaluation and treatment.
• Identify pelvic health dysfunction and determine appropriate referral.

• Utilize the Official Disability Guidelines for Low Back Pain.
• Apply the Official Disability Guidelines for the chiropractic treatment of low back pain.
• Use the CCGPP Guidelines for the treatment of low back pain.
• Integrate Outcome Assessments for clinical justification of chiropractic treatment low back pain.

• Utilize the Official Disability Guidelines for Neck Pain.
• Apply the Official Disability Guidelines for the chiropractic treatment of neck and upper back pain.
• Use the CCGPP Guidelines for the treatment of neck and upper back pain.
• Integrate Outcome Assessments for clinical justification of chiropractic treatment for neck and upper back pain.

• Utilize the Official Disability Guidelines for Shoulder Pain
• Apply the Official Disability Guidelines for the chiropractic treatment of shoulder pain
• Illustrate sensitivity and specificity of orthopedic tests for the shoulder
• Integrate Outcome Assessments for clinical justification of chiropractic treatment for neck and upper back pain

• Utilize the Official Disability Guidelines for Headaches.
• Apply the Official Disability Guidelines for the chiropractic treatment of headaches.
• Use the CCGPP Guidelines for the treatment of headaches.
• Integrate Outcome Assessments for clinical justification of chiropractic treatment for headaches.

• List and describe each Medicare required document, content requirements and timing rules
• Summarize and explain Medicare’s documentation requirements and how to comply with those requirements to improve patient care
• Examine and review how Medicare reviews PT and OT documentation
• Describe how to demonstrate and document medical necessity in order to treat patients and prepare for a potential appeal

• Interpret compliance advice and regulations directly from the Federal Office of Inspector General (OIG)
• Identify and become compliant with other requirements from the state level through third-party payer contractual obligations
• Review existing policy and procedure for compliance, including OIG compliance, HIPAA compliance, and other federal and state programs

• Apply guidelines for accurate coding and compliant billing practices
• Install monitoring to ensure standards are met
• Self-audit for compliance purposes
• Create internal policy and procedure to improve compliance

• Identify risk areas in the claim adjudication process and apply learned knowledge to prevent missteps
• Discuss federal, state, and payer guidelines that govern billing activities
• Avoid behaviors that violate the carrier contract and ensure compliance with regulations
• Evaluate provider contracts and payer policy for complete clarification on claim process

• Utilize self-auditing methods to identify high risk areas of patient finance in the office
• Develop systems for accountability and transparency in patient accounting
• Apply appropriate fee schedule measures to ensure validity in account posting
• Address federal and state guidelines for discounting to ensure compliance

• Apply the process for setting your fees legally and compliantly and according to Federal regulation
• Know the policies of ALL your carriers to be compliant
• Properly administer desired discounts without running afoul of the Federal and State regulations
• Implement legal hardship discounts, if desired, using the Federal guidelines to appropriately verify hardship

• Distinguish between the five most important federal fraud and abuse laws that apply to physicians
• Identify red flags in your practice that increase vulnerability
• Comprehend what has been discovered in previous OIG workplans and how to apply the findings to your practice
• Determine what entities require a formal compliance program for your office
• Develop an action list to start today for implement a Compliance Program for your clinic

Hour 1

• Discuss the Inflammatory Cascade
• Identify the mechanics of concussion that results in inflammation
• Describe the neuro-chemical cascade of concussion

Hour 2

• Perform physical exam protocols in inflammation as it relates to concussion
• Perform Neurological exam protocols in inflammation as it relates to concussion
• Perform Chiropractic exam protocols including incorporating AK exam
• Apply Chiropractic exam protocols in inflammation
• Utilize advanced examination protocols in inflammation

Hour 3

• Perform structural treatment protocols to treat inflammation related to concussion
• Utilize phytonutrient protocols to treat inflammation related to concussion
• Use specific therapeutic protocols to resolve inflammation with literature citations

• This contains all courses with the educational objectives listed from Concussion 201 through 202

Hour 1

• Discuss the Selye Stress Response
• Discuss the mechanics of concussion that results in the inflammatory response
• Describe the cortisol cascade response associated with concussion

Hour 2

• Perform physical exam protocols in the stress response
• Perform Neurological exam protocols in the cortisol cascade
• Apply Chiropractic exam protocols in the cortisol cascade
• Utilize advanced examination protocols in evaluating the stress response

Hour 3

• Perform chiropractic treatment protocols to treat the stress response
• Utilize nutritional protocols to treat inflammation related to the stress response and concussion
• Use evidenced based therapeutic protocols to address the cortisol cascade associated with concussion with literature citations

Hour 1 and 2

• Describe the components of the core and the function of the core.
• Describe the function of the diaphragm as it relates to posture, muscular relationships and stability of the spine.
• Describe the function and structure of the superficial muscle system of the body.
• Describe two concepts of spinal stability. 

Hour 3

• Demonstrate how to determine the length of quadratus lumborum and erector spinae. 
• Demonstrate how to evaluate Transversus abdominus function
• Demonstrate how to facilitate the core and initiate a core training program

Hour 4

• List three pathologies related to less than optimal core function.
• Describe three postural strategies that the patient may develop when the core is in dysfunction.
• Describe how weakness of the abdominals can alter diaphragm contractions.
• Explain how respiratory fatigue can alter core control.

• Develop an appreciation of the impact of culture group, minority group and racial group on the health care relationship
• Increase sensitivity, knowledge and skills to promote effective intercultural interactions
• Identify the professional's own cultural identity/judgments /biases and their impact on their behavior and how they are perceived by clients and patients
• Recognize cultural variables that appear in verbal and non-verbal communication
• Examine the influence of culture in our patient population
• Differentiate the provider's culture

• Examine the historical background of the various Latino/Hispanic groups in the U.S.
• Develop the skills needed to care for people from Spanish speaking parts of the world
• Increase our understanding of the cultural traits of Latino/Hispanic groups in the U.S.
• Summarize specific traits of various Latino/Hispanic groups
• Recognize how we can narrow the gap between us

• Develop an appreciation of the impact of culture group, minority group and racial group on the health care relationship.
• Increase sensitivity, knowledge and skills to promote effective intercultural interactions.
• Identify our own provider culture/judgments /biases and their impact.
• Examine characteristics of Asians, Blacks and Middle Easterners.
• Summarize how to care for patients of these three ethnic/racial groups and how to narrow the gap between us
• Develop an understanding/plan of how to reach out to these populations.

• Describe cultural diversity
• Recognize the need for cultural competence in health care
• Explain the concept of health disparity
• Define culture and cultural competence
• Differentiate between the concepts of culture, race, ethnicity, diversity, and minority
• Describe the Cultural Competence Continuum
• Discuss the interdependency between the levels of cultural competence

• Discuss the evolution of multicultural policy
• Describe the phases of multiculturalism
• Discuss three major perspectives on culture and diversity that have influenced healthcare literature and practice
• Identify the common myths and misconceptions associated with culture
• Recognize the paradoxical dilemmas associated with cultural competence

• Identify the need for cultural competence in health care and in medical literature.
• Examine and Research the historical perspectives
• Examine your world view or cultural beliefs about diversity and explain how you can develop an attitude of cultural competence.
• Analyze the five aspects of ethnicity used to describe cultural differences in the health care environment. 

• Review and explain the racial and ethnic disparities in health care.
• Explain the role of health care providers and organizations as mechanisms to reduce racial and ethnic disparities in health care. 
• Explain how language and communication of the health care provider can be a barrier to establishing relationships.
• Identify tools that can foster empathy for differing cultures.

• Explain the need for improving cultural awareness in the workplace to build cultural competency.
• Identify five practices that can be implemented to increase cultural awareness in the workplace.
• List the benefits of building an organization's cultural competence
• Explain how to deliver culturally competent care.

• Demonstrate The ability to communicate clearly and concisely with current and future patients 
• Describe ways to establish and maintain relationships and facilitate constructive interactions with individuals and diverse groups.
• List strategies to align personal and organizational conduct with ethical and professional standards that include a responsibility to the patient and health care community. 
• Demonstrate an understanding of the healthcare system and the environment in which healthcare managers and providers function.

• Describe diagnostic criteria in the presentation of dementia
• Describe aspects of cognition, ADL and behavior affected by dementia
• Become familiar with differential diagnosis for dementia
• Outline the management of dementia including pharmacologic and non drug therapies
• Review arguments for and against disclosure of a diagnosis of dementia

• Develop the skills for medical documentation record keeping for proper patient care and adherence to insurance protocols
• Summarize informed consent, Evidenced-based care, Medicare guidelines and NCQA guidelines
• Identify common treatment procedures and modalities used in a chiropractic practice And recognize contraindications to them
• designate specific items to consider when interpreting and/or taking plain film X-rays
• Summarize the value of laboratory and diagnostic testing.
• Recognize the importance of patient communication skills in order to assist in the diagnosis and treatment of patients
• Modify procedures and forms to prevent the possibility of a legal malpractice action against the doctor

Hour 1

• Utilize improved patient communication skills with Medicare Patients 
• Apply appropriate risk management procedures to enhance patient communication
• Identify the four elements of legal malpractice and recognize the key components to avoid a malpractice action  
• Utilize key components of good documentation and record keeping
• Integrate the legal requirements of informed consent in your informed consent process 

Hour 2

• Summarize why doctors are held to higher standards
• Discuss the Do’s and Don’ts of record keeping
• Use the 21 NCQA guidelines for appropriate medical record keeping and integrate the 3 key components of Evidence Based Practice (EBP)

Hour 3

• Assess Medicare’s mandatory Electronic Health Records (EHR) requirement        
• Discuss key items related to the Office of Inspector General (OIG) reports regarding Medicare and chiropractic services
• Summarize Executive Order issued by the White House titled reducing improper payments and eliminating waste in the Federal Programs

Hour 4

• Determine what triggers an audit and key items to consider if audited
• Utilize a step by step approach to meet all Federal Medicare Documentation guidelines 
• Summarize Medicare’s guidelines for necessity of chiropractic care and its covered services
• Prepare treatment plans per Medicare’s regulation requirements
• Recognize Medicare’s policy requirements pertaining to x-ray/diagnostic reimbursement
• Determine if ordering vs. referred services meet Medicare’s policy when performed by a chiropractic physician

Hour 1

• Demonstrate the key elements pertaining to Medicare’s documentation requirements for initial and subsequent patient encounters  
• Describe the three categories of chiropractic care covered through Medicare and the one category exempt from Medicare coverage
• Apply Medicare’s x-ray requirements for documenting a subluxation
• Utilize Medicare Advance Beneficiary Notification (ABN) form and its guidelines 
• Use Medicare’s PARTS system to document a subluxation
• Summarize the transformation of Medicare’s PARTS system utilizing the AIR S & M method               
• Include proper Medicare documentation for daily progress notes (SOAP), in order to meet insurance guidelines and meet medical necessity 

Hour 2

• Integrate a 4 step approach to meet E/M (Evaluation/Management) coding requirements to meet Medicare’s guidelines

Hour 3

• Review Medicare Access and CHIP Reauthorization Act of 2015 (MARCA) aka Medicare Quality Payment Program (QPP) and the Merit Based Incentive Payment Program (MIPS)                                                                    

Hour 4

• Apply the critical components of Chiropractic Manipulative Treatment (CMT) coding and Medicare’s requirements for documentation
• Use diagnostic codes ICD-10 (primary subluxation M-codes biomechanical lesions and secondary medical codes) to meet Medicare’s diagnosis requirements
• Recognize Current Procedure Terminology (CPT) codes and how it relates to the Medicare system
• Utilize Medicare modifiers   
• Identify some of the key items with regards to completing the Center for Medicare and Medicaid Services (CMS) 1500 claim form   
• Summarize Medicare’s mandatory claims submission policy                                   
• Explain the five levels of Medicare appeals process
• Distinguish between Medicare participating vs. non-participating provider requirements

Hour 1

• Define standard of care.
• Examine the requirements of Chiropractic documentation.
• Evaluate Chiropractic care and the functional relationship.
• Review state specific examples of documentation requirements.
• Discuss what is mean by episode of care.

 Hour 2

• Establish the baseline of care.
• Identify the inadequacies of intake forms.
• Comply with the requirements of the initial encounter report.
• Review the consultation documentation in various case scenarios.
• Apply appropriate medical decision-making processes and documentation.

 Hour 3

• Examine the Documentation Requirements of a SOAP Note.
• Utilize PART in documentation.
• Utilize outcome assessment tests in documenting medical necessity of care.
• Identify Assessment and its relationship to medical necessity.
• Solidify elements of the treatment plan to support medical necessity.
• Apprise utilization management and review analysis of documentation.

• Recognize the common pitfalls that can put your clinic at risk
• Review the difference between a mandatory ABN and a voluntary ABN
• Identify the appropriate time to initiate a mandatory ABN
• Implement customized and compliant ABNs for your clinic by following the rules

• Demonstrate understanding of the key elements of revised E/M services
• Determine the elements that count as Time-Activities and how to calculate appropriately
• Establish protocol to determine Medical Decision Making element of E/M encounter
• Apply the new algorithm to appropriately code for E/M services under the 2021 model
• Discover how to still demonstrate Medical Necessity with the revised E/M codes
• Determine why history and examination are still needed

• Develop the skills for medical documentation record-keeping for proper patient care and adherence to insurance value based parameters
• Recognize the importance, and benefits of thorough chart documentation from the standpoint of the patient, the provider, the profession and third-party payors
• Show how outcome assessment documentation benefits the patient, the provider, the profession, and third-party payors
• Demonstrate physical examination procedures that are the basis for diagnosis formulation and value based data
• Examine skills necessary to incorporate an outcomes-based, evidenced-influenced approach to patient-centered health care in bodily injuries

• Develop the skills for medical documentation record-keeping for proper patient care
• Recognize the importance and benefits of documentation methodology from the standpoint of risk management
• Identify selected documentation problems and errors
• Summarize recommendations for improving patient care documentation for those Doctors not using an EHR

• Define the Problem Oriented Medical Record (POMR).
• Demonstrate taking a complete patient history.
• Define the Evaluation and Management examination for the musculoskeletal system.
• Define Outcome Assessment.
• Illustrate the P.A.R.T. format of documentation.
• Define proper assessment for SOAP notes.
• Discuss proper documentation of treatment performed on each visit.
• Discuss proper documentation of treatment plans.

• Comprehend the reasons for transitioning from ICD9 to ICD10
• Determine the critical differences with the new ICD10 codes
• Utilize the proper alpha and numeric aspects of commonly used ICD10 codes for  Chiropractic
• Observe the practicality of combining clinical documentation and the proper use of ICD10 codes.

• Discuss the history of ICD-10-CM codes
• Discuss the Official ICD-10-CM Guidelines for Coding and Reporting
• Identify and discuss the tools needed to navigate the ICD-10 codes
• Discuss the General Equivalence Mappings (GEM’s) and their significance and how they relate to ICD-10-CM Tabular List of Diseases and Injuries
• Identify and discuss how to select the appropriate ICD-10 code to its highest specificity
• Examples to be discussed

• Recognize the key components regarding good documentation and record keeping
• Identify the legal requirements of informed consent and the key elements of the informed consent process
• Discuss why doctors are held to higher standards
• Describe the 21 NCQA guidelines for record keeping
• Document progress notes (SOAP) to meet insurance guidelines and medical necessity
• Apply the PARTS system and its transformation utilizing a new method AIR S & M
• Utilize CMT coding appropriately
• Utilize E/M (Evaluation/Management) coding appropriately to meet insurance guidelines and medical necessity
• Identify the 3 categories and 2 subcategories of E/M codes
• Identify the 5 levels of E/M services for new and established patients
• Identify the 7 components (descriptors) used to determine the level of E/M service
• Select the appropriate level of E/M services utilizing 7 simple steps

• Differentiate between active and maintenance care in clinical documentation
• Execute the use of advance notice in third party patients correctly and accurately
• Identify and implement strategies to clarify the difference between active and maintenance care in documentation
• Recognize and adopt best practices in proper notification about maintenance care vs. active treatment

• Properly document findings and recommendations around muscle therapies
• Master the documentation necessary in daily visits to verify medical necessity
• Identify and implement strategies the most important findings and rationale necessary to add muscle therapies to the treatment plan
• Recognize how to differentiate between various manual therapies to meet the requirements of third-party payers' medical review policy

• Differentiate between supervised modalities, constant attendance modalities, and therapeutic procedures
• Properly document the time and service for any physical medicine modality and procedure
• Clearly define the rationale for these services within the patient's medical record

• Recognize the varying specific requirements for documenting unique adjusting techniques in regards to compliant records and risk management
• Properly document patient encounters for medical necessity
• Discuss the Medical Review Policy insurers use in reviewing medical documentation
• Review case studies and examples to identify documentation errors during self-auditing

• Apply best practices for using abbreviations, addressing legibility, authentication of signatures, and managing the day-to-day flow of your patient records 
• Clearly delineate the beginning and end of episodes of patient care, proper recording of these episodes, and boundary discussions with patients 
• Locate and utilize the definitions of medically necessary care, and apply it as a differentiator from clinically appropriate care
• Assess documentation across the life cycle of the patient’s chart from history to discharge and on through maintenance and wellness care based on live examples demonstrated
• Identify the deficiencies that may be present in your documentation through the eyes of an auditor

• Utilize documentation requirements for the most commonly used CPT codes in the profession
• Apply coding techniques and algorithms to ensure the proper code is selected to meet E/M documentation guidelines
• Recognize the codes that carry the highest degree of risk and confirm that documentation meets the code requirements
• Identify the mandatory elements of medical review policy for selected chiropractic codes

• Compose Complete and Accurate Treatment Plans
• Formulate multiple Standard Treatment Protocols for better compliance and efficiency
• Differentiate patient care plans per Patient condition severity
• Propose recommendations based on exam findings, not third party coverage

• Discuss Medicare’s guidelines for documenting quality measures 
• Discuss Medicare’s Merit-Based Incentive Program (MIPS)
• Identify and determine the eligibility requirements for MIPS
• Identify and discuss the 4 categories under MIPS (Quality, Cost, Promoting Interoperability (PI) and Clinical Practice Improvement Activities (CPIA)
• Recognize how Medicare calculates MIPS to determine payment adjustments

• Know how to document exactly what’s required for initial visit treatment plans including physical medicine procedures
• Apply sample language to include in each daily visit note that will meet documentation guidelines for these modalities and procedures, including properly recording time for timed services
• Command the mechanics of how to authenticate documentation for services provided by auxiliary team members
• Tie the patient’s diagnosis to the treatment plan for tissue-specific, physical medicine solutions
• Tell a complete and coherent account of the patient’s daily visit journey, outlining the crucial language necessary to justify medical necessity for all services rendered

• Recognize and document the difference between active and maintenance care
• Use a decision-making matrix to determine the reportability of active treatment, and to be able to help the patient understand the distinction
• Apply the Medicare standard of recordkeeping to intake requirements to establish a baseline for episodes of care
• Determine whether routine visits qualify as active treatment when presented with new and updated complaints

• Describe the need for prognosis
• Summarize what a prognosis is
• Demonstrate the use of prognostic tools
• Appraise your individual patient’s outlook for recovery.
• Measure the progress
• Make evidence based clinical decisions
• Substantiate your opinion for expert testimony.
• Illustrate the evidence for care.
• Prescribe evidence based care plans.
• Properly document and code complicated cases
• Improve the patient report of findings and discharge procedures

Hour 1 - 5

• Describe the need for prognosis
• Summarize what a prognosis is
• Demonstrate the use of prognostic tools
• Appraise your individual patient’s outlook for recovery.
• Measure the progress
• Make evidence based clinical decisions
• Substantiate your opinion for expert testimony.
• Illustrate the evidence for care.
• Prescribe evidence based care plans.
• Increase your reimbursement for complicated cases.
• Improve the patient report of findings and discharge

Hour 6

• Interpret in documentation, the difference between active, medically necessary care vs. clinically appropriate but possibly maintenance adjustments
• Able to distinguish compensatory vs. primary subluxations and document them properly
• Specify proper documentation techniques as a full spine adjuster
• Demonstrate the ability to classify documentation for each chiropractic technique employed

• Interpret in documentation, the difference between active, medically necessary care vs. clinically appropriate but possibly maintenance adjustments
• Able to distinguish compensatory vs. primary subluxations and document them properly
• Specify proper documentation techniques as a full spine adjuster
• Demonstrate the ability to classify documentation for each chiropractic technique employed

• Perform functional testing to identify patients who will benefit from active care rehab
• Correlate functional testing findings with a protocol-driven care plan customized to the patient’s diagnosis
• Recognize and document preferred outcomes that result from properly executed active care techniques
• Follow clinical algorithms to best understand the beginning, middle and end points of active care rehab
• Properly document the clinical rationale for active care rehab by linking it to the diagnosis and treatment plan of initial visit documentation

• Discover all the elements necessary for appropriate documentation of an episode of care, from the initial visit through the discharge from active treatment
• Have clearer delineation of the beginning and end of episodes of patient care
• Decide when an active episode of care should turn into maintenance care, and document the decision making appropriately
• Identify the required components of documentation as they are outlined in state board documentation requirements, Medicare documentation requirements and other entities’ regulations

• Define and recognize common procedures that may be deemed unproven, investigational or experimental
• Determine how individual state boards and payers view these various treatments
• Recognize guidance or rulings from state boards that dictate the need for informed consent
• Properly document the procedures in the medical record
• Apply correct coding to describe the procedure provided
• Personalize a sample Consent to Treat for the procedure provided

• Awareness of the value of orderly documentation to you and others
• Ability to duplicate key documentation components that auditors and reviewers expect
• Steps necessary to address how poor documentation can turn a simple record review into a full audit
• Ability to identify commonly missed links connecting documentation to treatment

• Differentiate and document for the difference between medical necessity and clinical appropriateness
• Execute a complete and compliant treatment plan that includes all required elements
• Properly record the elements necessary to justify the full-spine adjustment
• Command the mechanics of properly documenting clinical rationale for ordered diagnostics and treatment
• Ensure the inclusion of diagnostic assessment and doctor’s rationale in routine daily visit notes

• Evaluate the necessary elements to properly document established patient re-evaluations of all types
• Deliver appropriate evaluation and management services to justify continued care, assess progress, and discharge from this active care when the time is right
• Report the necessary components of documenting the transitional diagnosis and treatment plan after a periodic re-evaluation
• Complete the fundamentals of documenting the assessment of change since the last evaluation as it applies to federal regulations in Medicare

• Recognize the mandatory enrollment guidelines for chiropractors.
• Distinguish between active and maintenance care.
• Employ proper procedure to administrate both active and maintenance types of care.
• Complete and document required elements of documentation of active treatment.
• Apply the Medicare standard of financial transactions with patients in order to stay within the Federal collection guideline.

• Discover how proper documentation impacts the revenue cycle and profitability of your office
• Distinguish between Medically Necessary and Clinically Appropriate Care
• Demonstrate how your office compliance program either leaves you vulnerable or reduces your risk
• Develop understanding of compliant fee systems
• Evaluate federal guidelines regarding discounting and/or hardship

• Discern Part B from Part C and know the rules for each
• Discuss mandatory enrollment necessary for Chiropractic specialty
• Master the definition of medical necessity vs. clinical appropriateness and who pays in either case
• Recognize the differences between acute, chronic, and maintenance car
• Locate and understand the Medicare Local Coverage Determination (LCD) for your state including all the rules and guidelines
• Identify CMT coding and how it is differentiated from maintenance in Medicare

• Discern Part B from Part C and know the rules for each
• Discuss mandatory enrollment necessary for Chiropractic specialty
• Master the definition of medical necessity vs. clinical appropriateness and who pays in either case
• Recognize the differences between acute, chronic, and maintenance car
• Locate and understand the Medicare Local Coverage Determination (LCD) for your state including all the rules and guidelines
• Identify CMT coding and how it is differentiated from maintenance in Medicare

• Understand the difference between clinically appropriate and medically necessary care
• Identify the clinical indications of when to initiate therapeutic withdrawal
• Execute the components of a final discharge evaluation with proper documentation and recommendations
• Learn how to transition a client from an active phase of care to maintenance as a part of your treatment plan

• Understand the difference between clinically appropriate and medically necessary care
• Identify the clinical indications of when to initiate therapeutic withdrawal
• Execute the components of a final discharge evaluation with proper documentation and recommendations
• Learn how to transition a client from an active phase of care to maintenance as a part of your treatment plan

• Cite the difference between Therapeutic Exercise and Therapeutic Activities
• Properly document all aspects required when utilizing timed therapy services
• Assimilate payer policy details to ensure proper code utilization
• Discuss common errors when documenting and billing exercise therapy services

• Demonstrate why each and every digit of the DX tells the payer something important Distinguish the nuances of specialized DX coding rules for carriers such as Medicare.
• Discover the importance of DX pointing, and which CPT codes are an absolute MUST to point to DX
• Illustrate how to diagnose with a higher level of specificity and through proper hierarchy Identify the role of the diagnosis in the documentation process'

• Identify the expected standards of a compliant and complete patient record
• Audit documentation to ensure the most important details are present
• Demonstrate how to conduct a complete baseline audit of record documentation

• Demonstrate the components of recognizing Medical Necessary Care vs. Clinically Appropriate
• Identify CMT coding trends and indicators as they relate to medical necessity
• Properly manage treatment effectiveness for exacerbations and reoccurrences
• Determine Proper Diagnosis and Assessment for Federal Patients
• Acknowledge and audit CMT coding ratios to evaluate the potential risk

• Identify Dually Eligible Individuals (QMB) and Understand How Medicare Works with Medicaid
• Ascertain the practice’s obligations for QMB patients, regardless of Medicaid participation or coverage
• Provide accurate and legal advance notice to dually eligible individuals within the new guidelines
• Recognize the differences between acute, chronic, and maintenance care and how that affects billing and charges
• Duplicate Medicare financial rules and collections guidance into a process within the practice

• Apply the changes in the 2022 ICD-10 code set to the clinical diagnosis process
• Compare examination findings, couple with history, to select the most appropriate written diagnosis
• Document within the clinical record your thought process of selecting diagnostic codes
• Classify diagnoses in order of severity and hierarchy to match projected treatment plan

• Properly document “doctor thinking” daily in routine patient visit documentation
• Recognize the role of the PART documentation process in Routine Office Visit notes
• Identify and execute the key components of written assessment in daily documentation
• Recognize aspects of documentation and coding of Route Office Visits (ROV) whether active treatment, preventative maintenance, or wellness care.
• Distinguish the unique components of Subjective, Objective, Assessment and Plan

Hour One: Documentation and Compliance Overview, Rules and Regulations

• Recognize and avoid or correct behavior that is contrary to the rule of “no opt-out for chiropractors”
• Apply compliance rules set forth by governmental agencies that apply to providers of service to Federally insured patients
• Demonstrate day-to-day application of guidance on Federal Program and state requirements for coding, billing, and finances
• Differentiate between active and maintenance care, according to the official Medicare definitions and other third-party guidelines
• Interpret the four types of risk the Office of Inspector General (HHS) expects providers to focus on with Policy and Procedure, per the OIG Guidance for Small Practices
• Recognize the limitations of experimental, investigational, and unproven technologies

 Hour Two: Documentation of Initial Visits-New Patients, New Episodes, and New Conditions

• Identify and apply concepts that differentiate types of initial visits, from new patients to updated episodes
• Produce documentation of initial visits that comply with board requirements for chiropractors
• Summarize documentation requirements as they apply to the new initial Evaluation and Management guidelines set forth January 1, 2021
• Establish medical necessity for your care and know with surety that initial visit documentation is complete
• Rank complicating factors and contraindications according to priority and include with initial assessment
• Populate a required treatment plan for care, whether for short- or longer-term care

 Hour Three: Documentation and Case Management for Routine Visits, Preventive Maintenance, and Wellness Care

• Differentiate between requirements for medically necessary services vs. maintenance which is self-pay
• Apply primary subluxation vs secondary compensation logic to mitigate risk for the full-spine adjustment
• Reproduce the key elements of routine chiropractic visits in documentation as set forth by third-party, State and Federal guidelines
• Interpret functional data to determine stages and levels of care
• Demonstrate the ability to implement therapeutic withdrawal and to document its results
• Recognize maximum therapeutic benefit (MTB) and properly document discharge from active treatment

 Hour Four: The Risks Associated Billing and Financial Compliance Regulations

• Give examples of billing and financial compliance that cross the line of False Claims Act and Anti-Kickback Statute violations
• Apply billing and financial compliance regulations to the day-to-day operations of the practice, including payment and prepayment plans
• Execute random auditing of charges and collections to meet OIG compliance guidelines
• Recognize and apply the rules of offering financial hardship discounts
• Produce advertising that falls within the guidelines of board and federal rules

• Label the main driver is for “Medical Necessity”, how and why you must communicate this to 3^rd party payers
• List the foundation of coding and be able to apply pertinent ICD10 coding guidelines
• Discover how correct coding may dictate our strength to 3^rd parties and have national implications for our profession.
• Discuss critical questions of the benefits and risks of our Chiropractic diagnosis codes in the insurance industry.
• Identify red flags, complicating factors, and have awareness of Risk management when documenting and coding.
• Identify how insurance companies rank the importance of various diagnoses and its effect on claims’ coverage and processing

• Know how to prepare for a medical emergency
• Review four emergency medical conditions: Stroke, Heart Attack, Difficulty Breathing, Diabetic Emergencies
• Recognize the causes, symptoms and signs for these emergencies
• Understand how to provide the appropriate emergency treatments

• Gain the knowledge to develop an Emergency Preparedness Manual for your office
• Define crisis management procedures in advance for fires, child abduction, workplace violence, bomb threats and other situations
• Explain the importance of an emergency continuity plan
• Recognize why CPR was changed and compare the new rules
• Perform more effective CPR even before you refresh your certification

• Recognize Altered Mental Status and apply the appropriate emergency response
• Distinguish types of Burns, their mechanisms of injury and pathophysiology
• Plan for the treatment of burns and the appropriate emergency response
• Apply and use the Rule of Nines
• Recognize Allergic Reactions, discuss their pathophysiology and the proper emergency response

• Identify the most common emergencies that occur on airline flights
• Describe what may be expected of you in caring for a patient at high altitude
• Describe what resources and equipment may be available to you as an in flight medical provider
• Observe important clinical differences seen on examination of patients on airplanes
• Demonstrate to patients skills to prevent medical emergencies during air travel

• Describe the basis of the American legal system
• Compare and contrast constitutional, statutory, common and administrative law
• List the differences between criminal and civil law
• Explain the civil litigation explosion
• Summarize tort reform

• Differentiate morals and ethics
• Explain the purpose of professional codes of ethics
• Compare and contrast legal and professional health care ethics
• Define situational ethics
• Identify the four principles of biomedical ethics

• List the external and internal factors affecting the exposure to malpractice liability
• Describe the legal basis for imposing malpractice liability of a patient injury
• Define the concept of abandonment
• Outline the four elements needed to prove malpractice
• Compare and contrast ordinary negligence versus professional negligence
• Explain vicarious liability
• Summarize defenses to malpractice actions
• Describe the importance of patient care documentation

• Describe the concept of intentional torts
• Differentiate assault and battery
• Define defamation, slander and libel
• Summarize the mandatory reporting requirements for health care professionals
• Outline the four principle forms of invasion of privacy
• Classify the types of criminal activity 
• Describe the steps in a criminal prosecution
• Explain the classifications of homicide

• Differentiate employment at will versus employment under contract
• Summarize the history of federal regulation of labor – management relations
• Describe the five major sections of the Americans with Disabilities Act of 1990
• Recognize sexual harassment in the workplace
• Define “ordinary reasonable person” as it pertains to sexual harassment
• Differentiate the vicarious liability of an employer relative to employees and independent contractors
• Explain the considerations in writing a letter of recommendation
• Outline the requirements for an enforceable restrictive covenant

• Summarize the antitrust laws
• Discuss the importance of the attorney – heath care professional client relationship
• Define the elements of a binding contract
• Explain breach of contract and possible contractual remedies
• Describe the various forms of business organization
• Outline the good Samaritan laws
• Recognize the requirements for HIPAA compliance
• Assess the necessity and limitations of professional liability insurance

• Summarize the major federal statutes regulating education
• Discuss federal education law derived from constitutional protections
• Outline a risk management strategy for academic discipline in health professional educational programs
• Assess liability for student conduct in the clinical setting
• Outline procedures to minimize liability when incorporating students in the clinical setting

• Explain patient informed consent to intervention
• List the requirements of sufficient informed consent
• Describe pertinent considerations in life and death decision making including euthanasia
• Recognize issues of nondiscrimination against participants in health care delivery
• Explain pro bono health care services
• Outline professional practice issues of financial responsibility and gifts
• Summarize the ethical issues of impaired providers and intra and inter-professional relations
• Define the ethical issues in research and the informed consent process

• Demonstrate the importance of communicating in an ethical manner and what that entails
• Develop an understanding of what 'spin' is, why it is unethical and how to monitor and minimize/stop it
• Evaluate the barriers to effective and ethical communication
• Develop an understanding of exactly what takes place/needs to take place during the provider/client interaction
• Discover what it is that patients want from their visits to a provider
• Appraise how to deal with challenging clients and situations
• Discover how to become a skilled helper by studying the tools of communication
• Apply listening skills to the provider's repertoire
• Demonstrate the importance of the impact of nonverbal communication on the caregiver/client relationship
• Develop, analyze and apply the verbal and nonverbal skills that will help to gather information and support the patient effectively
• Write an Ethical Communication Protocol (EPC) for your practice

• Determine how critical it is for us to take excellent are of ourselves
• Indicate the ways in which we can stay healthy physically, mentally and emotionally
• Examine the impact of stress on providers
• Recognize the issue of burnout
• Demonstrate the fiduciary duty that providers have

• Differentiate between assault and battery
• Outline various kinds of legal problems that may result from sexual impropriety claims
• Identify and describe distinctions between innocent flirtatious behavior and sexual misconduct
• Evaluate possible defenses to sexual misconduct Disciplinary complaints
• Discuss the applicability of the transference phenomenon to Doctors of Chiropractic

• Recognize the legal and ethical implications of billing, collections, fees, bartering, and financial gain
• Navigate the tricky waters of appropriate interaction with vendors/suppliers.
• Understand the fiduciary relationship that governs patient-doctor interactions.
• Grade your role as the chiropractor in all professional inter-relationships, including staff, patients, peers.
• Use self-assessment techniques to stay compliant in all areas of ethics and boundaries.

• Identify legal prohibitions against promising healthcare cures, guaranteeing treatment results, and deceptive patient communication.
• Distinguish between appropriate and inappropriate communication relating to patients' healthcare prognoses and progress.
• Explain scientific literature linking patients' mental states with healthcare outcomes.
• Demonstrate alignment between compliance with states' current patient communication restrictions and instances of patient encouragement that foster mental states favorable to desired healthcare outcomes.
• Explain office procedures and staff training which are likely to ensure ongoing ethical patient communication and the documentation thereof.

• Identify challenging/inappropriate patient requests and behaviors encountered by chiropractors.
• Explain prevention strategies, office procedures and effective responses to inappropriate patient activity.
• Describe safety concerns associated with a patient's inappropriate acts and communications, as well as ethical principles related thereto.
• Illustrate legal and ethical issues arising where the doctor/patient relationship is terminated due to inappropriate patient behavior.
• Analyze how aberrant patient behavior presents risks to staff, the treating doctor, and to fellow patients, and how proper documentation is important in such instances.

Hour 1

• Define Ethics
• Review various ethical issues recently reported on
• Identify ethics as related to the whistleblower
• Discuss Ethical standards specific to laws in various states

Hour 2

• Discuss Ethical standards specific to laws in various states (cont’d)
• Summarize awareness related to anti-discrimination
• Classify various aspects of professional boundaries and sexual misconduct

• Define anti-aging medicine
• Compare and contrast the differing opinions on anti-aging medicine
• List the moral questions associate with the anti-aging movement
• Describe how the anti-aging movement is viewed from a feminist perspective

• Describe the moral questions concerning home care for the elderly
• Identify the relationship between the cared for and the care giver
• Explain the focus of governmental programs for dependent elderly care
• List the values necessary to support elder care at home

• Outline the history of the nursing home
• Describe the evolution of bioethical thought on nursing home care
• List strategies for creating a more ethical nursing home environment
• Ways nursing homes can aid residents in addressing end-of-life concerns

• Give examples of the roots of an ageist attitude in the United States
• Describe the dynamics of the power relationship between care giver and cared for
• Explain the issues involved in setting boundaries in the institutional environment
• Describe the difference between independent and relational autonomy

• Define elder abuse, neglect and self-neglect
• Describe the “expressive – collaborative” model of approaching ethics
• Compare and contrast the classical definition of autonomy with “actual autonomy”
• Explain how remaining in an abusive / neglectful environment may constitute the best alternative for an individual

• Cite the historical perspective on senility
• Describe how the pervasive bioethical viewpoint affects the experience of people with dementia
• Explain the concepts of dignity
• Compare and contrast various definitions of dignity relative to those with dementia

• List the foundational assumptions that define advance care planning in the United States
• Differentiate hospice care from palliative care
• Describe the issues that arise when individual choice is the main focus of advance care planning
• Explain how the modern culture of medicine influences end – of – life care
• Compare and contrast the current approach towards end – of – life care with the authors. “bottom up,” approach

• Cite examples of how the elderly have been marginalized during disasters
• Define what is meant by the “axes of susceptibility”
• Identify the ethical obligation to the elderly during major disasters
• Describe how planning, communication and coordination is an ethical imperative in disasters
• Explain the concept of “place holding,” and how it fits into disaster planning

• Define morality and ethics and distinguish between the two
• Describe three moralities that health professionals must integrate into their own moral life
• Identify some major sources of moral beliefs in Western societies
• Distinguish between an ethical issue and ethical problem
• List three ways that ethics is useful in everyday professional practice
• Describe what material cooperation entails
• Identify some mechanisms available to protect the personal moral convictions of health professionals

• This contains all courses with the educational objectives listed from Ethics for Professionals 101 to Ethics for Professionals 105.

• Identify the goal of professional ethics activity.
• Describe the basic idea of a caring response and some ways this response in a professional relationship is distinguished from expressions of care in other types of relationships.
• Identify three component parts of any ethical problem.
• Describe what an agent is and, more importantly, what it is to be a moral agent.
• Name the three prototypical ethical problems.
• Describe the role of emotions in ethical distress.
• Distinguish between two varieties of ethical distress.
• Compare the fundamental difference between ethical distress and an ethical dilemma.
• Define ethical paternalism or parentalism.
• Describe a type of ethical dilemma that challenges a professionals desire (and duty) to treat everyone fairly and equitably.
• Identify the fundamental difference between distress or dilemma problems and locus of authority problems.
• Identify four criteria that will assist you in deciding who should assume authority for a specific ethical decision to achieve a caring response.
• Become familiar with AOTA and APTA Code of Ethics
• Become familiar with the Guide to Professional Conduct for PT
• Indiana PTs - become familiar with the IN PT Rules and Practice Act
• Texas PTs - become familiar with the TX PT Rules and Practice Act
• Utah PTs - become familiar with the UT PT Rules and Practice Act

• Identify six steps in the analysis of ethical problems encountered in everyday professional life and how each plays a part in arriving at a caring response.
• Describe the central role of narrative and virtue theories in gathering relevant information for a caring response.
• List four areas of inquiry that will be useful when gathering relevant information to make sure you have the story straight.
• Describe the role of conduct-related ethical theories and approaches in arriving at a caring response.
• Describe why imagination is an essential aspect of seeking out the practical alternatives in an ethically challenging situation.
• Discuss how courage assists you in a caring response.
• Identify two benefits of taking time to reflect on and evaluate the action afterward.
• Become familiar with AOTA and APTA Code of Ethics
• Become familiar with the Guide to Professional Conduct for PT's

• Define the terms confidential information and confidentiality.
• Identify the relationship of a patient's legal right to privacy with his reasonable expectations regarding confidential information.
• Describe how the telling and keeping of secrets is relevant to understanding the importance of confidentiality.
• Discuss the ethical norms involved in keeping and breaking professional confidences.
• Name five general legal exceptions to the professional standard of practice that confidences should not be broken.
• Consider practical options that a professional can take when faced with the possibility of breaking a confidence.
• Discuss some important aspects of documentation that affect confidentiality.
• Compare ethical issues of confidentiality traditionally conceived with those that have arisen because of computerized medical records and patient care information systems.
• Describe the key ethical strengths and challenges of the recent U.S. federal regulations related to privacy considerations (Health Insurance Portability and Accountability Act of 1996).
• Become familiar with AOTA and APTA Code of Ethics
• Review and become familiar with the TX PT Rules
• Read case scenarios illustrating ethical decision making

• Describe three basic legal concepts that led to the doctrine of informed consent.
• Describe three approaches to determining the disclosure standard for judging that a patient or client has been informed.
• Discuss three major aspects of the process of obtaining informed consent.
• Distinguish "general consent" from "special consent" documents.
• Differentiate between the never-competent and once-competent patient or client and the challenges posed by each in regard to informed consent.
• Compare informed consent as it is used in health care practice and in human studies research.
• Describe some considerations one must always take into account to be sure one is being culturally competent and honoring cultural difference when informed consent is the standard.

• Assess the current literature on outcomes assessment in chiropractic practice
• Describe the psychometric properties outcome measures
• Summarize the utility of patient related outcome measures
• Outline the various domains of outcome assessments
• Describe the clinical significance of common patient reported outcome measures
• Identify guidelines and recommendations for use of outcomes measures in daily practice
• Identify clinician driven outcome measures and discuss the strength of evidence supporting them along with their clinical significance and utility

• Define Evidence Based Practice (EBP)
• Identify problems/obstacles to EBP
• Outline the process of EBP
• Learn how to ask good clinical questions: PICO
• Describe how to search PubMed and learn how PubMed translates a search query
• Define MeSH terms and describe their use
• Illustrate how to limit or broaden your search to find the appropriate content
• Compare the results of boolean operators AND, OR and NOT

• Provide a rationale for the use of outcome assessments in practice
• Survey the recommended outcome assessment measures used by chiropractors and provide a copy or link to download them electronically
• Describe the recommended outcome measures and provide instruction on how to score them
• Detail the psychometric properties of the commonly used outcome measures to aid in determining clinically relevant change in patients
• Indicate which outcome measures to use and when to use them

• Evaluate the effectiveness of the influenza vaccine in healthy adults and children 
• Evaluate the effectiveness of the influenza vaccine in the elderly 
• Evaluate the importance of influenza vaccination in those with recent cardiac events 
• Explain the key elements in the "Tamiflu Controversy" 
• Discuss limitations to the Tamiflu research base 
• Discuss limitations to using zinc for the common cold 
• Evaluate strengths of study design for pragmatic trials 
• Discuss the effectiveness of using probiotics for the common cold 

• Recognize the initiation and growth of evidence-based  (EBP) or evidence informed practice (EIP)
• Interpret the need to utilize EBP
• Define EBP.
• Explain the levels of evidence and applications to practice
• Contrast EBP/EIP with what is not EBP/EIP and relate to your clinical expertise.
• Evaluate the research evidence for application to practice
• Locate the literature that applies to the doctor’s patient
• Integrate the literature research with their clinical expertise and the patient preferences
• Recognize patient preferences
• Distinguish your patients from the benchmarks of care
• Distinguish the different types of evidence
• Synthesize EBP/EIP into case studies
• Implement EBP/EIP procedures to your practice for increased patient compliance,
• Differentiate individual patient cases with similar diagnoses
• Identify actions contingent upon the level of evidence

• Hypothesize situations where being able to critically evaluate research on your own may be particularly important
• Recall the original definition of evidence-based medicine
• Identify point-of-care resources for high quality evidence
• Categorize the evidence-based resources into point-of-care, summaries, syntheses etc.
• Define “bias” in the context of research studies
• Discover risk of bias in randomized controlled trials as it relates to unmasking and blinding
• Paraphrase the meaning of a “straw man” in the context of study design
• Discover risk of bias in randomized controlled trials as it relates to industry sponsorship, specifically referencing spin, straw man design, selective outcome reporting
• Identify the aspects of ‘non-specific effects’
• Define minimal (clinically) important difference
•  Explain why minimal important differences may be more relevant than p values
• Apply research findings to the patient in front of you