Join an ECHO Program at the IU Richard M. Fairbanks School of Public Health!

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6AVQM3WxBhvJnggCbttWXd5Pc3EqWiSaG3qyx73ckq2X3EsMgxIMHCq4wE6xKTE3caajSMvI9k9jVeXfoZaduzkuLr86nFsiNZ9XBzRe3LfCrB85UE

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Joining an ECHO program is easy and free! No-cost continuing education credit is awarded for each live session for:

Physicians
Pharmacists
Nurses
Social Workers
Certified Health Education Specialists (CHES/MCHES)

Please check your registration email that details the specific continuing education credits each program provides. Each ECHO program includes regularly scheduled teleclinics consisting of collaborative case-based learning and brief, informative didactics. ECHO program schedules are listed below.

Black Maternal Health (BMH) ECHO: 1st and 3rd Wednesdays from 11:30 - 1:00 pm ET. Note: This program is currently in recess for program planning. Calendar invites will be sent at a later time and date. Programming will resume early 2025.
Cancer Prevention & Survivorship Care ECHO: Programming will resume Winter 2024. Register now to receive the launch announcement!
Indiana Public Health Response ECHO: Every other month on the 2nd Wednesday of the month, 8:00-9:00 am ET. Note: This program is currently in recess for program planing. Calendar invites will be sent at a later time and date.
Hepatitis C (HCV) ECHO: 1st & 3rd Thursdays, 12:30-2:00 pm ET
HIV ECHO: 2nd Thursdays from 8:30-10:00 am & 4th Thursdays from 12:30-2:00 pm ET
Comprehensive Pain Management (CPM) ECHO: 1st & 3rd Mondays, from 12:00-1:15pm ET
LGBTQ+ Health ECHO: 2nd & 4th Wednesday of the month, 2:30-4:00 pm ET

ECHO sessions meet online using Zoom. To participate, you only need to have access to the Internet. A webcam is strongly encouraged but not absolutely required.

Previous IU Indianapolis ECHO Center participants, please DO NOT complete this form. If you're interested in registering for a new series or updating your information, please notify Liz Culp at elculp@iu.edu.

For which ECHO Clinic would you like to register?

See above for the times that each ECHO program meets!

* must provide value

Hepatitis C (HCV) ECHO

LGBTQ+ ECHO

HIV ECHO

Cancer ECHO

Comprehensive Pain Management (Formerly Integrated Pain Management) ECHO

Public Health Response (Formerly COVID-19 Response) ECHO

Black Maternal Health ECHO

Please list your name as you prefer to be addressed
(First & Last Name)

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Pronouns

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Please list your pronouns

Job Title

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Do you have an NPI number?

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Yes

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NPI Number

Professional Credentials
(please check all that apply)

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ATC

BA/BS

BSN

CCHW

CD(DONA)

CHES

CNM

CPM

DDS

DrPH

FNP

LCSW

LDH

LMHC

LPN

LSW

MA/MS

MBA

MCHES

MHA

MPH

MSN

MSW

PCD(DONA)

PharmD

PhD

RDH

Student

Other

None

Please list other credentials

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Please indicate which type of continuing education credits you would like to receive

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AMA PRA Category 1 Credit for physicians

AAFP Credit for family physicians

ACPE contact hours for pharmacists

ANCC contact hours for nurses

Category 1 CEU for social workers

CHES/MCHES credits

None

Are you interested in pharmacy CMEs?

Yes

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Please provide your date of birth. This is required for pharmacy CMEs.

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M-D-Y

Please provide your NABP or ACPE number. This is required for pharmacy CMEs.

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Are you interested in CHES/MCHES credit?

* must provide value

Yes

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What is your CHES ID number?

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Specialty

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Addiction Medicine

Allergy & Immunology

Anesthesiology

Cardiology

Cardiac & Thoracic Surgery

Critical Care

Colon & Rectal Surgery

Dermatology

Emergency Medicine

Family Medicine/General Practice

General Surgery

Geriatric Medicine

Hospice & Palliative Medicine

Hospitalist

Infectious Disease

Interventional Radiology

Internal Medicine

Neurology

Neurosurgery

Nuclear Medicine

Obstetrics/Gynecology

Oncology

Opthalmology

Orthopedic Surgery

Otolaryngology/ENT

Pain Medicine

Pathology

Pediatrics

Physical Medicine & Rehabilitation

Plastic Surgery

Preventive Medicine

Psychiatry/Mental Health

Pulmonary Disease

Radiology

Radiation Oncology

Rheumatology

Sports Medicine

Urology

Vascular Surgery

Gender Health

Other

None

Other

Practice / Organization

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Healthcare Organization, Physician Affiliation or Group (e.g., Physicians at IU Health)

Is your office a Federally Qualified Health Center (FQHC)?

Yes

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Thank you for signing up for the HIV ECHO.

As a federally funded program, our collaborators at MATEC Indiana request that you create a profile and register via the following link:

https://www.matec.info/event/?ER_ID=37137

Email Address

* must provide value

Mobile Phone (required for CME crediting)

* must provide value

Office Phone

Office Extension

Fax

How did you hear about ECHO?

Word of Mouth

Existing ECHO Participant

AANP Nashville Conference 2024

Table or Exhibit

Conference Presentation

IUHP Primary Care Leadership

IUH Residency Program

Contacted by Katherine Davis

Facebook

Twitter

Another social media

Other

Please provide more detail regarding how you heard about ECHO

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By checking this box, you are authorizing the IU Indianapolis ECHO Center to take and utilize your photos, video, and/or statement - personal and/or organizational - regarding experiences with the IU Indianapolis ECHO Center for any media communications, including social media, for advertising/marketing purposes or grant program evaluations and reports.

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Do you have access to a video camera to participate in the ECHO sessions?
(If you select no, we will follow-up to provide one.)

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Yes

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Please click "Submit" to go to the next step.

If you need assistance, please contact ECHO Director, Andrea Janota.
ajanota@iu.edu | (317)-274-3178

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