South Carolina Chiropractic Continuing Education

• 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

• 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

• Identify the key players in the patient provider relationship
• Recognize the key documentation requirements and components required to be eligible to treat Veterans
• Compose documentation that meets  required VA elements
• Locate key resources for successful referral management
• Determine key factors known to be often missing, and understand what to do to correct the deficiency
• Demonstrate the proactive steps to take in treating VA patients from clinical and financial submission

• 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

• Develop an understanding of the physiologic principles involved in nerve depolarization and the propagation of action potentials as they relate to Motor and Sensory nerve conduction studies
• Identify the physiology and nerve pathology in clinical conditions presenting in Chiropractic practice, and how they present on electrodiagnostic examination
• Classify the utilization of electrodiagnostic testing in the process of differential diagnosis
• Develop a working clinical knowledge of the setup and recording of Compound Muscle Action Potentials, Sensory Nerve Action Potentials, F-Responses in all major peripheral nerves, as well as H-reflex testing
• Demonstrate a practical knowledge of the neuroanatomy, as well as clinical applications of EMG and Somatosensory and Dermatomal Evoked Potentials

• 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

• 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.

• Identify the relationship between an upper cervical - trigeminal cervical nucleus and headaches.
• Integrate headache, upper cervical spine, and the temporomandibular joint.
• Distinguish between the clinical management of compressive neuropathology v. supersensitivity nerve interference.
• Identify “red flags” associated with compressive neuropathology.
• Discuss the relationship between mechanoreceptors, the sympathetic nervous system, and neuroimmunology.
• Highlight the uniqueness of upper cervical spine mechanoreceptors and the vagus nerve.
• Describe mechanobiology and diseases of mechanotransduction.
• Explain connective tissue as a body-wide signaling network.
• Summarize some randomized controlled/clinical trials pertaining to chiropractic and/or manipulation care.
• Recall studies looking at the influence of chiropractic care on opioid use.
• Interpolate the importance of sagittal posture on pain and function.
• Examine the importance of sagittal posture on cognition.
• Integrate evolutionary biology, infection, and the existence of chiropractic subluxation.           
• Summarize studies showing the influence of joint adjusting on a variety of visceral syndromes.
• Detail the relationship between an infectious agent and host health.
• Recognize the basic details of neuroimmunology.

• Identify the differences between the deposition and trial
• Understand the fundamentals and subtleties of the discovery of evidence
• Distinguish between discovery and impeachment
• Describe the steps involved in a deposition and trial
• Discuss critical issues encountered in the deposition and trial

• Demonstrate how to get started in marketing new skill sets
• Recognize how to contract work
• Establish case preparation protocols
• Distinguish between oral and written reports
• Describe the steps involved in opinion forming

• Discuss demonstrative evidence and props
• Distinguish between discovery and impeachment
• Understand the steps involved in a deposition
• Recognize the worth of your knowledge as a forensic examiner
• Review the steps involved in civil and criminal cases

• Understand the steps involved in a trial
• Identify critical issues encountered in a trial
• Create a defensible curriculum vitae
• Explain the concept of work product
• Discuss critical issues encountered in discovery of work product

• Understand critical issues encountered in a forensic practice
• Recognize pertinent case law
• Explain the concept of absolute immunity
• Recognize risk management protocols for the forensic examiner
• Discuss the future challenges for the forensic examiner

• Develop a level of knowledge and understanding of the federal and state legal system
• Develop a level of knowledge, comprehension, and understanding of the deposition process as it relates to the practice of forensic chiropractic and testifying as an expert witness
• Integrate the Rules of Evidence
• Illustrate which Federal Rules of Evidence apply to the expert witness
• Explain discovery techniques
• Discuss that the expert witness may need to produce business records
• Emphasize that each chiropractic provider must keep informed as to the laws and their interpretation in their particular state of practice
• Assess Daubert criteria
• Explain what each chiropractic expert should look for when preparing for the opposing attorney relating to hearsay
• Develop a level of knowledge, comprehension, and understanding of the medicolegal system as it relates to Daubert challenges

• Discuss trick question posed on cross examination
• Assist judges in implementing effective management of expert evidence involving scientific issues
• Identify judicial notice, aggregation, and compensation schedules for specific injuries
• Develop a level of knowledge, comprehension, and understanding of the cross examination process as it relates to the practice of forensic chiropractic and testifying as an expert witness
• Develop a level of knowledge and understanding of the federal and state court appointed expert process
• Discuss evidentiary framework
• Identify which Federal Rules of Evidence apply to the expert witness
• Critique the nature of the claims, the theories of general and specific causation, the defenses, and in particular the bases for disagreement among experts
• Explore the use of reference guides

• Integrate Scientific Reasoning vs. Methodology
• Critique questions relating to scientific validity
• Assess Frye criteria
• Discuss hearsay exceptions
• Explore statistical estimates
• Emphasize that judges will exclude certain evidence
• Identify scientific theories that are not testable
• Comment on forensic techniques that have fallen into disfavor
• Discuss implicit error

• Discuss the Reference Manual on Scientific Evidence
• Emphasize keeping junk science out of court
• Review and critique literature refuting whiplash syndrome
• Summarize the amended Rules of Evidence and their impact of Daubert
• Identify which Federal Rules of Evidence apply to the expert witness
• Demonstrate how to read a legal opinion
• Assess the concept of ipso facto as it relates to the practice of forensic chiropractic and testifying as an expert witness
• Integrate case law as it relates to the practice of forensic chiropractic and testifying as an expert witness

• Develop a level of knowledge, comprehension, and understanding of the federal legal system as it relates to malpractice and testifying as an expert witness
• Explain punitive or exemplary damages
• Discuss the "but for" test
• Assess the concept of res ipsa loquitur
• Summarize battery and assault
• Emphasis adequate informed consent
• Contrast breach of contract or warranty to cure
• Detect the opposing attorney's intent
• Develop a level of knowledge, comprehension, and understanding of the ethical expert witness

• 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.

• This includes all content from Functional Medicine 201 thorugh 205. Please see educational objectives for those courses

• 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.  

• Provide an understanding of the clinical applications of biochemical/metabolic evaluations to determine a patient’s hormonal status
• Explain the differences between various assessments of hormonal status
• Evaluate hormonal imbalances and disorders
• Evaluate nutrient needs in metabolic disorders Plan and monitor nutrient interventions to correct abnormalities found by the tests

• Describe the origin of mitochondria from an evolutionary perspective.
• Understand the critical role that the thyroid plays in metabolism and how this relates to healthy mitochondrial function.
• Explain how to test for mitochondrial function/dysfunction.
• Show how living in a thermos neutral modern society contributes to obesity.
• Recognize how antibiotics can damage mitochondria and how that can play a role in obesity.
• Give examples of toxins/drugs that can adversely affect mitochondria.

• Describe how common mitochondrial genetic problems are in the general population.
• Explain how mitochondria are needed to produce glutathione and why glutathione is needed for healthy mitochondria.
• Discover how oxidative stress can be both good and bad for the body.
• Discuss how mitochondrial dysfunction plays a key role in a variety of diseases ranging from Parkinson’s, Cancer, NASH, Alzheimer’s, Autism and Diabetes.
• Discover key ways to optimize mitochondrial function in patients.

• Describe the associations of micronutrient deficiencies as it relates mental health disorders.
• Demonstrate an understanding of major prescriptive medications and their negative influence on mental health disorders. 
• Explain the overlap of certain pathophysiological conditions and mental health disorders.
• Recognize the current lack of proper diagnosis of mental health disorder.

• Describe the associations of micronutrient and nutritional deficiencies as it relates mental health disorders.
• Demonstrate an understanding of the major biochemical pathways, their enzymes and nutritional elements as it relates to psychological issues.
• Explain the importance of fatty acids in mental health disorders.
• Recognize the current lack of proper nutritional interventions as it pertains to TBI, mTBI and PCS.

• Provide an understanding of the clinical applications of biochemical/metabolic evaluations to determine a patient’s status of nutrients, toxicants and cell regulators, and functional gastrointestinal status.
• Explain the differences between various assessments of element status
• Evaluate specific nutrient deficiency states
• Determine weaknesses in digestive, assimilative and intestinal microbiological status
• Plan and monitor nutrient interventions to correct abnormalities found by the tests

• Define and explain the difference between "calories in, calories out" versus the “carbohydrate-insulin model of obesity”. Discuss the causes of increased intestinal permeability in competitive athletes and identify strategies to combat the condition. Identify the energy intake athletes require by calculating their total energy expenditure.
• Recall the quality and function of macronutrients and their role in physical performance.
• Describe common micronutrient deficiencies seen in competitive athletes and identify strategies to prevent such occurrences.

• Summarize the physiological energy and macronutrient requirements of the sprint/power athlete and game-playing athlete. Identify supplement strategies to support the sprint/power athlete and game-playing athlete.
• Summarize the physiological energy and macronutrient requirements of the endurance athlete.
• Identify supplement strategies to support the endurance athlete.
• Outline an effective whole food diet to support competitive athletes.

• Describe the secondary metabolites in whole foods.
• Understand the role of phytochemicals.
• Demonstrate an understanding of how they interact with our cells.
• Explain how to preserve them during cooking.

• Recognize the challenges caused by ultra-processed foods
• Identify the compounds in the Brassicaceae family
• Explain the health benefits of sulforaphane
• Explain the importance of preserving secondary metabolites
• Recognize the benefits of the fungal kingdom

Hour 1

• Describe the characteristics and mechanisms of actions of essential oils.
• Explain several key controversies in aromatherapy and the implications.
• Generalize the safety and quality issues surrounding the clinical use of essential oils.
• Compare the various modes of applications of essential oils.
• Summarize the pharmacology and biotransformation of essential oils and its constituents.
• Recognize the potential interactions of essential oils with medications and nutraceuticals.

Hour 2 

• Generalize the various considerations for prescribing essential oils.
• Calculate equivalent dosages of essential oils using several different units of measurement.
• Apply the guidelines for appropriate prescribing the internal use of essential oils.
• Determine the proper application and dosage for various essential oils used for digestive health.
• Specify the usage and dose determination for essential oils for mental health.

• Analyze the concept of central pain processing and the consequences of dysfunction of descending inhibition.
• Associate FM with trauma and abuse, depression, anxiety, sleep disorder and pain processing disorders with emphasis on limbic system dysfunction, aberrant stress physiology, and ultimate failure of descending anti-nociception. 
• Assess the difference between regionalized somatic pain and true central allodynia
• Describe the accurate differential diagnosis of patients presenting with suspicion of FMS
• Identify common subsets of clinical disorders that may lead to an erroneous diagnosis of FMS (i.e., “pseudo” FMS)

• Describe and Identify the functional medicine approach to common pediatric problems
• Develop a comprehensive functional medicine assessment and treatment of common pediatric problems such as constipation, headaches and migraines, upper respiratory infections and otitis media, food sensitivities, allergies, asthma and atopy
• Examine the salient features of history, physical examination and laboratory testing to best implement functional medicine interventions to common pediatric problems
• Utilize a functional medicine approach to assess what each child may need to get or get rid of to treat each of these common pediatric problems 
• Summarize the literature supporting the use of functional medicine in pediatrics
• Recognize the four pillars of a functional medical approach to chronic pediatric illness – gastroenterologic, immunologic, metabolic and neurologic
• Classify and explain the importance of the genetic and genomic susceptibilities/predisposition and environmental triggers of chronic pediatric illnesses
• Utilize a functional medicine approach to assessing and treating chronic pediatric disease such as ADHD, Autism, Autoimmune Encephalitis, Anxiety, Allergy and Atopy
• Interpret the literature citations and develop protocols based on emerging evidence supporting a functional medicine approach to these chronic pediatric problems
• Appraise the assessment and management of the importance of the microbiome in immune tolerance, allergy and autoimmunity.

• Discuss the catecholamine pathway will be presented in an organized fashion with emphasis on real world applications. 
• Review clinical case studies. 
• Assess different genetic mutations within the catecholamine pathway . 
• Individualize treatment plans in practice. 
• Demonstrate a basic road map of the catecholamine pathway. 
• Use genetic parsing software and the tools attained form this course to highlight and modulate genes/SNPs of interest. 
• Derive natural therapeutic agents to modulate epigenetic expression. 
• Utilize basic nutrigenomic assessment and treatment knowledge in the catecholamine pathway.

• Define and explain the different terms that identify exercise intensity and their relationship to maximal oxygen uptake (VO2 max).
• Discuss the history of exercise physiology and how technology influenced research and ultimately, exercise guidelines.
• Differentiate the physiological responses to sprint interval training and to low-to-moderate intensity continuous training.
• Reconstruct a lay explanation to patients and/or clients of why sprint interval training is an extremely effective strategy for improving overall health and fitness.
• Summarize key research studies that support sprint interval training.

Hour 2

• Recognize additional research that supports sprint interval training.
• Identify key physiological benefits of sprint interval training.
• Recall important case study benefits.
• Outline effective overall strategies for implementing sprint interval training.
• Distinguish appropriate sprint interval exercises for differing populations.

Hour 1:

• Summarize the differences between genomics, genetics, and epigenetics
• Illustrate how genomics can affect risk and outcomes in auto-immune and inflammatory conditions
• Interpret relative function of genes based on presence of relevant SNPs
• Identify genes and SNPS involved in autoimmune disease and chronic inflammation
• Assess Dietary, Lifestyle and Herb/Nutrient recommendations based on genomics

 Hour 2:

• Apply nutritional genomics in autoimmune and inflammatory diseases
• Outline basic disease pathogenesis in autoimmune and inflammatory diseases
• Explain which genes and SNPs are relevant depending on the clinical scenario
• Assess other contributors to chronic inflammation and autoimmune disease

• Summarize the current state of legal status and research on fecal microbial transplants (FMT)
• Describe the state of research of FMT for irritable bowel syndrome
• Describe the state of research of FMT for hepatic encephalopathy
• Describe the state of research of FMT for antibiotic associated diarrhea/dysbiosis
• Describe the state of research of FMT for ulcerative colitis
• Describe the state of research of FMT for Clostridium difficile infection
• Describe the state of research of FMT for autism

• Define leaky gut
• Recall basic histology/molecular biology involved in leaky gut
• List conditions associated with leaky gut
• Compare diagnostic tools in the differential diagnosis of leaky gut
• Recite how the lactulose mannitol test works
• List therapeutic interventions for leaky gut

• Define Small Intestinal Bacterial Overgrowth (SIBO) 
• List common causes/ associations/risk factors of SIBO
• Recall the various estimates of SIBO prevalence
• Explain why SIBO prevalence estimates vary
• Describe the trajectory of SIBO research over the past decades

• Explain the limitations of using breath tests for the diagnosis of SIBO compared to other alternatives.
• Describe the specific issues with glucose-based breath tests for SIBO diagnosis.
• Describe the specific issues with lactulose-based breath tests for SIBO diagnosis.
• Critique the North American consensus document on breath testing for SIBO

• Implement the 2020 ACG Guidelines as it relates to breath testing for patients with IBS.
• Implement the 2020 ACG Guidelines as it relates to breath testing for patients taking PPIs.
• Discriminate between normal and abnormal ppm of H2S on a breath test.
• Contrast between the microbial diversity of the small intestine in those with and without SIBO.
• Identify the aberrant organism most associated with SIBO in the REIMAGINE study.
• Implement the 2020 ACG Guidelines as it relates to testing IBS patients for food sensitivities.
• Implement the 2020 ACG Guidelines as it relates to the use of low FODMAP diets in IBS patients.
• Select the Gut Directed Hypnotherapy regimen associated with the largest effect size.
• Explain the need for GRADE within the context of Guideline development.
• Critique a guideline using the AGREE-II criteria.
• Define the concepts of pre- and post-test probability.
• Calculate a post-test probability.

• Describe the role of GRADE in Guideline development
• Recall the recommendations of the ACG SIBO Guidelines
• Identify key concepts of SIBO as delineated by the authors
• Appraise the ACG Guidelines

• Recall the pathophysiology of the progression of Barrett’s esophagus to adenocarcinoma
• Implement the 2022 ACG guidelines on the use of PPIs for Barrett’s esophagus
• Evaluate the conclusions from the three competing meta-analyses on PPIs for Barrett’s
• Apply relative risk reduction calculations to the determination of the benefit of PPIs for Barrett’s

Hour 1

• Distinguish what gases are measured with Aire versus Aire2
• Judge the diagnostic agreement between Quintron and Aire devices in patients suspected of having SIBO
• Map the relationship between ‘fermentation scores’ and ppm
• Illustrate how you could use the Aire device to conduct formal SIBO breath tests

Hour 2

• Extrapolate hydrogen levels in the background of high methane
• Compare and contrast the pros and cons of using the Aire device
• Implement the clinician dashboard for breath testing
• Clarify why CO2 levels are not needed for Aire

• Recall the most common symptoms which H2S patients present with 
• Identify which H2S treatment interventions led to a statistically significant rate of adequate patient response 
• Evaluate an H2S SIBO case with a focus on severity and treatment history 
• Determine reasonable treatment options for an H2S SIBO case

• Examine the impact of sexual boundaries on the health care relationship
• Recognize the most common misconceptions about sexual boundaries
• Distinguish between sexual misconduct and sexual harassment
• Demonstrate the need for providing safety for patients
• Identify the inherent dangers of being in a power position

• Define sex abuse
• Identify the characteristics of an abused individual
• Appraise the effects of abuse on the health care relationship
• Create an individualized Patient Protection Protocol
• Develop office procedures and policies that will create a safe and comfortable environment for all patients

• Summarize the effect of exercise on wound healing in older adults
• Discuss the relationship between trunk muscle composition and functional capacity
• Assess the effects of high-intensity strength training on balance
• Describe a study that examines the reliability and validity of a new steadiness measure
• Assess the effect of an endurance exercise program on depression, anxiety and quality of life

• Summarize the concept of mitochondrial degeneration
• Discuss the free-radical mitochondrial theory of aging and the susceptibility of the brain to oxidative stress
• Assess the relationship between mitochondrial decay and age-related neurodegenerative diseases, such as Alzheimer's disease (AD) and Parkinson's disease (PD)
• Illustrate the array of mitochondrial nutrients and the various vitamins that may improve mitochondrial function

• Breakdown the biomechanical processes of spinal degeneration
• Explain the biochemical processes that occur in the geriatric population in 
• Differentiate between various diagnosis of structural and chemical conditions seen in geriatric patients
• Analyze the radiological findings and how they influence clinical decisions
• Explain Syndrome X and how it affects physiology
• Differentiate trauma and its late effects on the body

• This contains all courses with the educational objectives listed from Geriatrics 103 through 106

Hour 1

• Describe psychoneuroimmunology and its application to clinical diagnosis of geriatric patients
• Apply psychoneuroimmunology to activities of daily living

Hour 2

• Differentiate clinical approaches to managing psychoneuroimmunology
• Measure clinical treatment outcomes

Hour 3

• Relate what factors contribute to this field in the elderly patient
• Incorporate hormonal balancing with nutrition in clinical treatment plans for Chiropractic Patients

• Implement nutrients that promote spinal and joint function to obtain positive clinical outcomes
• Explain Ph., alkalinity and acidity as it impacts the physiology of the body in regards to healing
• Categorize toxins in the environment that create clinical presentations of  geriatric patients clinical care
• Utilize vitamins herbals and supplements to augment patients’ care
• Factor nutritional aspects of protein, fats and carbs into clinical treatment plans to improve healing
• Create treatment goals and nutritional plans

• Assess various treatment modalities
• Implement treatment protocols as found in the latest research
• Progress patients to incorporate wellness into their lifestyle
• Perform postural evaluations and discuss clinical significance to the patient
• Appropriately factor radiographic findings into diagnosis and clinical decision making of the geriatric patient
• Examine physical findings and set specific and measurable patient treatment goals

• This contains all courses with the educational objectives listed from Geriatrics 106 through 108

• Review evidence-based recommendations regarding best practices for chiropractic care of older adults
• Outline the relationship between individual sagittal posture and risk falling in an elderly back pain population
• Explore the cost impact of utilizing chiropractic in older patients with chronic low back pain and multiple comorbidities
• Examine the effectiveness of nonpharmacological therapies for dizziness in older people
• Assess the impact of chiropractic care on measures of sensorimotor function associated with the risk of falls in older adults

• Summarize the United Nations (UN) Decade of Healthy Aging and its initiatives
• Describe challenges specific to conducting clinical research on older patients
• Examine epidemiological trends and opportunities related to an aging population
• Define agism and elderspeak
• Explore relevant concepts of, and goals for, healthy aging
• Outline relevant clinical considerations for aging patients in a chiropractic practice
• Specify red flags in older patients that would warrant clinical referral
• Assess general function in elderly patients using simple clinical tests
• Examine our unique clinical opportunities (and challenges) relating to providing chiropractic care for older patients
• Recognize the clinical impact of multi-site pain in elderly patients
• Cite existing data on chiropractic care patterns for older patients
• Summarize and critique the existing body of research on chiropractic care for spinal conditions in older patients
• Explore the relationship between hip and spine function in elderly patients
• Integrate existing literature pertaining to the patient experience and understand what matters to them
• Summarize best practices for providing chiropractic care for older patients
• Discuss the rational use of imaging in chiropractic practice
• Define osteoarthritis and review the societal impact of this condition
• Identify risk factors for the development of osteoarthritis
• Outline our current state of knowledge on the pathophysiology and diagnosis of osteoarthritis
• Appraise the state of the evidence regarding general treatment recommendations for osteoarthritis
• Explore the scientific literature regarding various treatment modalities for osteoarthritis
• Recognize the value of exercise for managing osteoarthritis
• Critique the literature regarding common medical interventions for osteoarthritis
• Define lumbar spinal stenosis and review the societal impact of this condition
• Classify pathognomonic signs and symptoms of lumbar spinal stenosis
• Differentiate lumbar spinal stenosis from other clinical conditions
• Breakdown the evolving evidence relating to the management of lumbar spinal stenosis
• Discover the important role chiropractic can play in the treatment of lumbar spinal stenosis
• Outline our current state of knowledge on the pathophysiology and diagnosis of degenerative cervical (spondylotic) myelopathy
• Recognize the importance of identifying this pathology in aging patients to facilitate appropriate care

• Discuss ethical standards of insurance reporting and coding
• Illustrate how documentation can affect state board complaints
• Discuss why insurance companies file complaints against chiropractors
• Discuss why patients file board complaints against chiropractors
• Define the Problem Oriented Medical Record (POMR)
• Illustrate taking a thorough history using the OPQRST method
• Discuss the components of the ortho/neuro exam

Hours 1 - 3

• Discuss ethical standards of insurance reporting and coding
• Illustrate how documentation can affect state board complaints
• Discuss why insurance companies file complaints against chiropractors
• Discuss why patients file board complaints against chiropractors
• Define the Problem Oriented Medical Record (POMR)
• Illustrate taking a thorough history using the OPQRST method
• Discuss the components of the ortho/neuro exam

• Discuss the misrepresentation of certain orthopedic tests
• Illustrate sensitivity and specificity of orthopedic tests
• Define the 2021 changes to Evaluation and Management codes
• Discuss the differences between using time vs. medical decision making for E/M
• Distinguish between subjective and objective outcome assessments Illustrate methods of proving medical necessity
• Illustrate the CMS requirements of chiropractic documentation
• Illustrate condition-specific functional outcome questionnaires
• Define the A of P.A.R.T. from Centers for Medicare/Medicaid Services
• Define the R of P.A.R.T. from Centers for Medicare/Medicaid Services
• Illustrate the different methods of evaluating spinal range of motion
• Define the T of P.A.R.T. from Centers for Medicare/Medicaid Services
• Describe the timing of the first re-assessment
• Demonstrate proper coding for range of motion measurements
• Describe the P.A.R.T. format of documentation
• Define the P of P.A.R.T. from Centers for Medicare/Medicaid Services
• Describe the concept of outcome assessments in clinical practice

• Illustrate different outcome assessments for the T of P.A.R.T
• Demonstrate the POMR and P.A.R.T. formats for the initial patient encounter
• Integrate the POMR and P.A.R.T. formats for subsequent patient encounters
• Discuss proper diagnosing in notes and on a claim form
• Define the short, moderate and long-term diagnoses for Medicare
• Define proper Assessments
• Illustrate how to determine an assessment for each condition
• Illustrate complicating factors that can be documented for each condition

• Illustrate the two types of Plan
• Discuss common therapeutic modalities
• Demonstrate proper documentation for time-based codes
• Illustrate how to document measurable treatment goals
• Describe the red flags of a record review
• Demonstrate the determination of causation for a motor vehicle collision
• Discuss the different mechanisms of injury for motor vehicle collisions
• Discuss some of the key value drivers of Colossus
• Discuss the difference between impairment and disability
• Illustrate the determination of the end of justifiable treatment
• Define the main components of an impairment evaluation
• Illustrate Duties Under Duress and Loss of Enjoyment
• Illustrate the important diagnoses for personal injury cases
• Define the 5 Colossus prognoses
• Demonstrate the 5 grades of injury severity for the Croft Guidelines for the Treatment of CAD Injuries

• Prepare to manage and document protocols, for litigation protection, in a crisis, such as Covid.
• Discover how to avoid a HIPAA investigation and becoming a ‘HIPAA statistic’, often by surprise.
• Operate an office with protocols to avoid ransom ware and other Cyber-attacks.
• Complete a HIPAA program to be prepared for document production, demanded by the government, when a complaint (or even a simple inquiry) is made by a patient, peer, or ex-employee.

• This contains all courses with the educational objectives listed in Government HIPAA and Cybersecurity Compliance 201 - 208

• Prepare for the required OIG compliance program, required for all who treat one of more Medicare patients per year.
• Aid in understanding and preparing required written documented policies under the HIPAA law.
• Identify what thieves do with stolen patient information.
• Discover what is included in a comprehensive table of contents for a HIPAA compliance program.
• Describe the type and number of complaints against doctors and their often surprise origins
• Use of required accounting logs

• Classifying what you say and when, when notified of an investigation or audit, to avoid saying the wrong thing and complicating your case.
• Examine what every office must do, regarding the ONC law, to deliver patient records electronically if so requested, even if you don’t have computers.
• Show a step-by-step approach to responding to the government in the event of a breach, investigation, or audit.
• Solve the puzzle as to avoiding audits and compliance investigations.

• Explain tele-health pros and cons.
• Categorize the risks that lead to being turned in for violations, often not knowing you were doing anything wrong.
• Point out the most common HIPAA scams that involve impersonating a federal official.
• Examine the parts of the HIPAA law that enforcers are enforcing and those parts they are not enforcing.

• Discover how to conduct the required ISAR (information system activity review) that leads to maximum fines if not completed.
• Aid you and/or your staff in conducting the required risk analysis that leads to maximum fines, if not completed.
• Prepare an electronic device maintenance schedule to protect yourself relative to data breaches.
• Examine how to reduce your exposure to HIPAA fines.

• Discover illegal fee structures and the legal options that do exist.
• Prepare the four requirements relative to the notice of patient privacy policy.
• Generate a legally required BAA process for every individual or company with whom you share or provide access to your patient data.
• Discuss the requirements for data recover and emergency mode operations under HIPAA.

• Prepare a protocol for creating required policies under HIPAA.
• Assess the risks of seeing Medicare patients with inadequate use of the ABN form.
• Operate proper procedures to appropriately use the ABN form in a Medicare practice.
• Summarize the Ohio workers’ compensation requirements that elevate chiropractic and put restrictions upon spinal surgeons.

• Generate proper staff training to meet HIPAA requirements.
• Examine the pitfalls around a physical plant audit and what you must do to avoid them.
• Completing a required disciplinary policy that will pass an investigation.
• Classify the little-known training requirements above and beyond the ‘annual HIPAA training’.

• Make required changes to existing HIPAA forms and policies, due to the new HIPAA laws, that went into effect June of 2024.
• Asses your office readiness for the recently announced start of random HIPAA audits, to be conducted by the Office of Civil Rights
• Determine the individual actions you must take, regarding the new FinCEN requirements, to avoid $500 per day fines.
• Outline the latest updates from Washington DC HIPAA and Cybersecurity symposium and what to do to offset risks posed to chiropractors.
• Assess and prioritize the actions needed to prepare for the future of government health care compliance.

• Identify ePHI assets within the clinic and assess exposure to threats and vulnerabilities
• Understand how to create an action plan and implement Security Safeguards
• Recognize the components of the Risk Assessment that must be considered when developing policies and procedures

• Manage Risk Assignments and assign Target Dates to comply with federal requirements
• Audit Risk Factors that may be present
• Manage Security Events that may come up during the course of everyday workflow
• Set up Workforce Security Standards to be complied with by all team members
• Ongoingly Monitor Security Safeguards to ensure the integrity of your data and minimize risk

• Recognize PHI Identifiers- Know what you are looking for
• Identify important components of the Notice of Privacy Practices and how it puts the patient in the driver seat
• Execute, track and audit Business Associate Agreements
• Apply the rules of Patient Authorizations regarding when TPO applies

• Discuss the history of HIPAA and its application to the Chiropractic office
• Interpret the terminology of HIPAA i.e.: PHI, IIHI, NPP, TPO, NPI, EIN, EDI, etc.
• Contrast covered entities vs. non-covered entities
• Create a HIPAA compliant practice
• Utilize appropriate Electronic Data Interchange (EDI), code sets, identifiers, security and privacy
• Apply the Privacy Rule, Patient Consent Form, Notice of Privacy Practices, Patient Authorization, Business Associate Agreements, Appointments of Privacy Officers and Staff training
• Provide patient their proper rights as it pertains to access of their medical information, records and your practice etc

• Recognize acute situations for which homeopathic remedies are appropriate and effective
• Apply limited homeopathic remedies to acute care situations that arise in practice and day- to-day life
• Evaluate methods of application of homeopathic remedies to fit the situation at hand
• Distinguish between the available homeopathic remedies for a specific situation in order to select the most appropriate remedy for the individual
• Use homeopathic remedies in concert with existing therapeutic training

Hour 1

• List 3 factors which impact the mechanical properties of fascia
• Recall 3 important functions of fascia
• Cite 3 negative biological effects of fibrosis
• Describe 3 proposed neurophysiological effects of IASTM
• Itemize three biological effects of IASTM

Hour 2

• Cite 8 indications for using IASTM for upper/lower quarter musculoskeletal conditions
• Provide 8 indications for using IASTM for upper/lower quarter musculoskeletal conditions
• Enumerate 8 indications for using IASTM for upper/lower quarter musculoskeletal conditions
• when using IASTM for musculoskeletal disorders.
• List 2 features of IASTM tools and the effect that these features have on the treatment effect (tissue penetration)
• Summarize 5 IASTM basic stroke techniques
• Apply IASTM techniques for over 30 common upper quarter musculoskeletal conditions

Hour 3

• Outline 3 general purposes for using instrument-assisted soft tissue mobilizations (IASTM) for lower quarter musculoskeletal disorders.
• Recall 3 clinical indications for using IASTM to the hip
• State 3 clinical indications for providing IASTM to the lumbar spine
• Present 3 clinical indications for using IASTM for knee-related musculoskeletal disorders
• Itemize 3 clinical conditions of the lower leg and foot for which IASTM would be appropriate

• Acquire additional skill sets in impairment and disability rating
• Develop cognitive interpretive thinking in addressing impairment and disability issues
• Expand the current knowledge base required by the AMA Guides 5th edition

• Develop a level of knowledge, comprehension, and understanding of the medicolegal system as it relates to apportionment
• Minimize risks and failure risks when addressing the apportionment issue
• Encourage development and nurturing of skill sets risks when addressing the apportionment issue based on evidence-based literature and science
• Identify action steps for minimizing risks when addressing the apportionment issue

• Identify some of the criteria used by formally trained forensic examiners
• Identify certain practices that lead forensic examiners to question the credibility of reports or "IME providers"
• Develop a level of knowledge, comprehension, and understanding of the criteria used by impairment rating reviewers
• Identify certain practices that lead impairment rating reviewers/auditors to question the credibility of reports or raters
• Encourage development and nurturing of skill sets when formulating an impairment rating based on evidence-based literature, science and AMA Guides 5th edition criteria
• Identify action steps for minimizing risks when submitting an impairment rating report

• Identify some of the criteria used by formally trained forensic examiners
• Identify certain practices that lead forensic examiners to question the credibility of reports or "IME providers"
• Develop a level of knowledge, comprehension, and understanding of the criteria used by impairment rating reviewers
• Identify certain practices that lead impairment rating reviewers/auditors to question the credibility of reports or raters
• Encourage development and nurturing of skill sets when formulating an impairment rating based on evidence-based literature, science and AMA Guides 4th edition criteria
• Identify action steps for minimizing risks when submitting an impairment rating report

• Produce accurate impairment rating reports.
• Identify AMA Guides the criteria for CTS
• Develop a level of knowledge, comprehension, and understanding of the criteria used for rating CTS
• Identify certain practices that lead impairment rating reviewers/auditors to question the credibility of reports or raters
• Identify the commonly occurring errors seen in rating impairment due to CTS.