North Carolina Naturopathic Physician Continuing Education

• 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

• 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

• 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

• Explore contemporary healthcare issues from the perspective of Robert Lustig, MA and John Abramson, MD.
• Integrate the relevance of these issues to the chiropractic profession.
• Evaluate at the concept of evidence-based “medicine,” especially the “randomized controlled trial,” and describe how it applies to the chiropractic profession.
• Discriminate recent examples of “randomized controlled trials,” especially as related to pain syndromes and opioid drugs.Discusss the importance of the 2021 Nobel Prize for the chiropractic profession and mechanical-based care.
• Detail the physiology of the Piezo1 mechanical receptor.
• Introduce the concepts of mechanical function and mechanical neurology.
• Integrate the importance of the cerebellum to mechanical integrity and mechanical based care.
• Explain a randomized clinical trial that supports mechanical-based chiropractic care for visceral physiology.
• Distinguish the basic physiology of the neurotransmitter norepinephrine.
• State the basic physiology of the neurotransmitter dopamine.
• Outline the basic physiology of the neurotransmitter serotonin.
• Integrate the balance of the neurotransmitters dopamine and serotonin.
• Recite the relationship between the neurotransmitters dopamine, epinephrine and norepinephrine.
• Explore the concept of Heart Rate Variability (HRV).
• Integrate upper cervical chiropractic care, spinal chiropractic care, and HRV.

• Describe the relationship of the sympathetic nervous system and immunology.
• Relate the sympathetic nervous system and headache.
• Emphasize the importance of the opiate receptors in the periaqueductal gray matter and pain suppression.
• Summarize activation of the periaqueductal gray matter with chiropractic adjusting for pain suppression.
• Define the tensegrous matrix as relevant to chiropractic assessment and care.
• Integrate electrical nerve interference as a component of the subluxation complex.
• Explore the “corking” of cerebral fluid flow as related to the occiput-atlas subluxation.
• Define the prevalence, patterns, and predictors of chiropractic use by the US population.
• Empathize the importance of the first-class lever system of upright posture to the chiropractic profession.
• Establish the functional and physiological relationship between the brain and the cervical spine.
• Discuss the integrated physiology between inflammation, fibrosis, the Gate Theory, and chiropractic adjusting.
• Create a model of pain based upon the fibrosis of repair, motion, and the Gate Theory.
• Complete an interactive model of neuroimmunology using mechanoreceptors, the sympathetic nervous system, norepinephrine and neurological magnification.
• Complete an interactive exercise of spinal mechanoreceptor driven vestibular nuclei controls of somatic function and visceral function.
• Integrate the importance of constant v. non-constant thalamic summation/integration.

• Appreciate the current epidemiologic trends in autoimmune incidence, morbidity and mortality in the Western industrialized countries versus the under-developed world.
• Acknowledge the importance placed in human biology on mucosal immunity and the massive amount of immune tissue and functional resources dedicated to GI mucosal immune surveillance.
• Comprehend the linkage and association between autoimmune disease prevalence and factors including the GI microbiota composition, stealth infections, and molecular mimicry.
• Apply clinical laboratory testing related to autoimmune disease risk assessment and diagnosis, including qPCR molecular-based evaluation of the GI microbiota.

• Appreciate the current epidemiologic trends in autoimmune incidence, morbidity and mortality in the Western industrialized countries versus the under-developed world.
• Acknowledge the importance placed in human biology on mucosal immunity and the massive amount of immune tissue and functional resources dedicated to GI mucosal immune surveillance.
• Comprehend the linkage and association between autoimmune disease prevalence and factors including the GI microbiota composition, stealth infections, and molecular mimicry.
• Apply clinical laboratory testing related to autoimmune disease risk assessment and diagnosis, including qPCR molecular-based evaluation of the GI microbiota.

• Identify the differences in methodology and application between quantitative molecular testing (qPCR) versus next-generation sequencing of the GI microbiota in the support of clinical decision making.
• Synthesize the available evidence-based integrative and complementary therapeutic GI antimicrobial interventions for treating GI dysbiosis, including in subjects with autoimmune disorders.
• Explore the linkage and association between autoimmune disease prevalence and food immune reactions and sensitivities.
• Apply the available evidence-based integrative and complementary therapeutic interventions using pro and pre-biotics for improving the GI ecology in subjects with autoimmune disorders.

• Identify the linkage and association between autoimmune disease prevalence and factors including lack of early diverse antigen exposure (i.e., the hygiene hypothesis).
• Interpret the available predictive autoantibody test options for autoimmune disorders.
• Learn to determine when to order the available clinical laboratory testing related to autoimmune disease risk assessment, diagnosis, and clinical management, including qPCR molecular-based evaluation of the GI microbiota, various food sensitivity assays, and predictive autoantibody tests.
• Apply evidence-based integrative and complementary therapeutic interventions for improvement of the GI mucosal health and barrier function (i.e., leaky-gut syndrome) in autoimmune disorders. 

• Utilize clinical decision making related to the linkage and association between autoimmune disease prevalence and individual factors, including the GI microbiota composition, food immune reactions, stealth infections, molecular mimicry, and lack of early diverse antigen exposure, in practical clinical cases.
• Interpret the available clinical laboratory testing related to autoimmune disease risk assessment, diagnosis, and clinical management, including qPCR molecular-based evaluation of the GI microbiota and predictive autoantibody tests in specific practical clinical case scenarios.
• Apply the available evidence-based integrative and complementary therapeutic interventions for autoimmune disorders in specific practical clinical case scenarios.
• Refer to other medical specialists and collaborative care opportunities in complex autoimmune disease clinical case scenarios.

• Identify the risks and complications of long-term PPI (Proton Pump Inhibition) exposure, complicating factors increasing our risks and their correction, and “best practices” for prescribing this therapy.
• Demonstrate a hiatal hernia correction technique with a Chiropractic Adjustment
• Integrate and apply phytotherapy treatment of different causes of dysmotility (SIBO, SIFO, IBD, IBS, neuropathy) based upon identifying key colonocyte target receptors in both TH1 (autoimmune) VS TH2 (allergic) situations.
• Identify and summarize Metabolic Inflammation, explain its’ triggers, resultant diseases and prescribe treatment for it.
• Discuss inflammation in the Intestine-Lung axis, apply dietary and lifestyle preventative and corrective treatment.
• Develop the use of therapeutic “biotics” for asthma, airway inflammation, and atopic disorders,
• Associate GI and respiratory biodome imbalances with asthma and allergic disorders, and their relationship to allergic sensitization
• Critique the interaction of the hygiene hypothesis and our “window of opportunity” to prevent asthma and allergic diseases
• Apply home and office based environmental therapy to help limit daily allergic exposure, allergy and asthma reactions.

Hour 1:

• Discuss PNI and its relationship to musculoskeletal conditions
• Review the interaction of the Hippocampus-Pituitary-Adrenal axis with PNI and its effect on musculoskeletal conditions Discuss clinical approach to managing these syndromes

Hour 2:       

• Explain what factors affect the baby boomer population
• Establish Patient education and doctor patient relationship
• Establish protocols to improve treatment outcomes

Hour 3:

• Mind over matter- how the brain and neuropathways affect musculoskeletal conditions
• Describe cellular structure connections
• Evaluate patients with musculoskeletal conditions and consider the effect of the mind, body, cellular and neurological alterations manifesting of these conditions.

• Identify the Importance of the Microbiome in Leaky Gut Syndrome
• Examples of symptoms of Leaky Gut Syndrome
• Discuss the health conditions caused by Leaky Gut Syndrome
• Breakdown the causes of Leaky Gut Syndrome
• Explain Nutritional Therapies used to heal Leaky Gut Syndrome

• Explain the importance of Glutathione as a Nutritional Therapy.
• Demonstrate the Symptoms of Alzheimer’s, Liver dysfunction, Lung conditions and Eyes, Ears, Nose and Throat conditions and the benefits of Glutathione therapy in each case.
• Discuss abstracts that illustrate the benefits of Glutathione therapy in Alzheimer’s, Liver and lung dysfunction and conditions of the Eyes, Ears, Nose and Throat.
• Illustrate the primary benefit of Glutathione therapy for Alzheimer’s and conditions of the liver, lung and ears, eyes, nose, and throat.
• List the primary precursors for Glutathione in the body.

• Simplify the progressive cause-effect relationship of disease from biochemical imbalances to physiological disturbances to cellular/organ degeneration to disease manifestation
• Identify the five primary underlying etiologies of virtually all chronic degenerative disease
• Analyze the most common antecedents and triggers that predispose your patients to disease
• Devise an evaluation algorithm that efficiently guides your testing recommendations
• Discover novel in-office testing procedures that cost-effectively demonstrate patients’ nutrient insufficiencies; unmanaged stress; toxic burden; and sleep “debt”
• Evaluate Heart Rate Variability test results to easily measure and demonstrate patients’ stress adaptability as well as their response to treatment modalities
• Discriminate the meaningful information gleaned from Bio-Impedance Analysis (BIA) testing for monitoring your patients’ health restoration progress
• Interpret evaluation results to efficiently identify which primary factors are contributing to your patients’ health challenges
• Prioritize treatment plans that address both short-term goals (symptomatic relief) and long-term goals (correction, stabilization and prevention)
• Distinguish which nutraceuticals best support patient needs based on history, exam, testing and symptomatology
• Communicate the functional medicine model of health and disease with your patients with greater clarity and ease

• This contains all courses with the educational objectives listed from Functional Medicine 209 through 212.

• Design an efficient and cost-effective approach to evaluating your patients’ underlying health challenges
• Select key questions to ask your patients (consultation, history, questionnaires) to hone-in on their principal underlying imbalances
• Discover in-office, economical evaluation tools to efficiently reveal key diagnostic clues
• Create a systematic decision-making process that directs your testing recommendations
• Devise a practical and effective formula to skillfully evaluate gut health (dysbiosis), adrenal imbalance, blood sugar dysregulation (dysglycemia); oxidative stress; methylation defects; thyroid insufficiency; and sex hormone imbalances
• Generate a logical treatment sequence to competently treat the fundamental underlying conditions revealed in your evaluation
• Differentiate which nutraceuticals best support and rebalance underlying physiological imbalances.

• Identify the appropriate candidates (patients) for a detoxification program
• Effectively communicate the need for detoxification support
• Ensure a safe and comfortable detoxification experience
• Establish realistic expectations - for you and your patient
• Measure the outcome of your patient’s detoxification using novel, in-office, cost-effective evaluation procedures
• Generate 14 and 21 day detoxification programs
• Devise detoxification programs for various levels of patient commitment and participation
• Easily and readily respond to common patient questions and concerns about detoxification
• Address post-detoxification clinical considerations and directions

• Identify the most common pre-disposing factors for the initiation of cancer
• Design a screening protocol to evaluate cancer risk factors
• Discover specific evaluation procedures that identify biochemical imbalances indicative of cancer risk
• Interpret specialized laboratory test results that portray a physiological environment conducive to cancer promotion
• Devise treatment strategies shown to reverse cancer related imbalances
• Hone diagnostic skills by reviewing and analyzing a series of patient case studies, inclusive of history, exam findings, lab test results
• Develop safe and effective treatment recommendations for some of the more common chronic degenerative conditions, e.g., thyroid imbalances, chronic fatigue, inflammatory bowel disease

• Explain how beneficial commensal microbes support gastrointestinal health
• Describe the major components of the intestinal barrier
• Summarize the microbial composition of a typical stool sample
• Explain the role of comprehensive stool testing in assessing gastrointestinal health

• Recognize the three most common types of microbial dysbiosis
• Describe common factors that can reduce beneficial microbes and disrupt the intestinal barrier
• Assess pathogens and opportunistic microbes identified with comprehensive stool testing
• Discuss how the selection of microbial testing methodology may affect the identification of pathogens and opportunists
• Outline therapeutic approaches that address common dysbiosis types identified via comprehensive stool testing

• This course contains all courses with the educational objectives listed from Functional Medicine and Nutrition Virtual Classroom 201 through 210

• Describe the current epidemiologic trends in autoimmune incidence, morbidity and mortality.
• Associate the linkage between autoimmune disease prevalence and factors including the GI microbiota composition, food immune reactions, stealth infections, molecular mimicry, lack of early diverse antigen exposure, and other elements.
• Examine the available clinical laboratory testing related to autoimmune disease risk assessment, diagnosis, and clinical management, including qPCR molecular-based evaluation of the GI microbiota.
• Explain the difference between quantitative molecular testing (qPCR) versus next-generation sequencing of the GI microbiota in the support of clinical decision making.
• Appraise the available evidence-based integrative and complementary therapeutic interventions for autoimmune disorders.

• Describe the current common routes and mechanisms of toxic exposure for individuals living in the industrialized world.
• Associate the linkage between chronic diseases, including mitochondrial dysfunction, obesity, diabetes, Alzheimer’s disease, Parkinson’s disease, cancer and others with increased levels of exposure to various environmental and food toxins.
• Examine the available clinical laboratory testing related to toxic load and related disease risk assessment, diagnosis, and clinical management using various lifestyle and nutritional approaches.
• Explain the difference between the various methods to assess toxic burden and detoxification at the level of the individual in the support of clinical decision making.
• Appraise the available evidence-based integrative and complementary therapeutic interventions for lowering toxic load and improving detoxification function.

Hour 1

• Describe the general diagnostic criteria of Metabolic Syndrome and CVD.
• Demonstrate an understanding of the enhanced diagnostic criteria and the importance of investigating these potential earlier markers.
• Demystify the “Cholesterol and HDL hypothesis” and explain the compensation mechanisms of the body for this.
• Recognize the biometric and physical signs of the progressive nature of CVD, CHD and MetS.
• Investigate Lifestyle Modification Programs as the major intervention strategy for the reversal and stagnation of these comorbidities. 

• Describe the general dietary interventions of Metabolic Syndrome and CVD.
• Demonstrate an understanding of sodium/salt as it relates to CVD/HTN.
• Demystify the confusion of major supplements and foods as it relates to CVD/HTN. 
• Recognize the associations between insomnia and CVD, CHD and MetS.
• Investigate various peer reviewed studies and the outcomes of nutritional interventions.