Presentation Application Form
Presentation Length:(Must be 60 minutes in length)
Title of Presentation:
Primary Presenter:
Present Position
(Title and Description):
Prefix (Dr.): Suffix (RN):
Organization:
Department:
Address:
City, State, Zip:
Phone:
Fax:
E-mail:
List a bio-sketch that includes educational background and briefly describes
professional experience and/or areas of expertise.
Additional Presenter:
Present Position
(Title and Description):
Prefix (Dr.): Suffix (RN):
Organization:
Department:
Address:
City, State, Zip:
Phone:
Fax:
E-mail:
List a bio-sketch that includes educational background and briefly describes
professional experience and/or areas of expertise.
Level of Presentation Content: Advanced Intermediate General
Focus of Session Content
 Lecture  Panel Discussion
 Interactive Seminar  Workshop
 Case Study
Session Area of Emphasis:
 Quality / Patient Safety  Compliance / Regulatory Issues
     New COP's
     Joint Commission
     CHAP
     CR 5567
 Data (Clinical & Operational)
     Pain Management
     Symptom Management
     Use of Complementary Therapies 		 Palliative Care
     Billing
     Successes
 Volunteers
     Recruitment / Retention
     Working with Alzheimers Patients 		 Marketing
     Web Sites
     Fundraising
     Advertising
     Building Alliances
 Outreach to Referral Sources  Patient / Family Satisfaction
 Employee Satisfaction / Retention  Hospice Facilities / Free-Standing
     Residences
 Hospice in Nursing Homes  Hospice in Assisted Living Facilities
 Service Excellence Programs  Cultural Inclusion, Diversity and Access
Other:
Target Audience:
 Agency Leadership / Directors  Agency Leadership / Directors
 Patient Care Coordinators  Medical Directors
 Social Workers  Bereavement / Spiritual Care
 Patient Care Techs  Home Health Aides
 Volunteers
Other:
Behavioral/Learning Objectives: (Objectives are measurable and achievable, i.e. words such as describe, explain, identify, design and apply are measurable objectives for what a participant should be able to do after attending a workshop)
Brief Abstract: (no more than 50 words describing the content of the presentation—this will be used in the program brochure to describe your session)
Audiovisual Requirements: IHO will provide all AV equipment EXCEPT laptop computers. All rooms will be equipped with a head table and podium.
Flip Chart Overhead Projector LCD Projector
Other:

Questions or comments, please contact Stacey Nay, IHO, Director, Education Services at nays@ihaonline.org or 515.283.9309.