Infectious Disease Epidemiology

INFECTIOUS DISEASE EPIDEMIOLOGY Multi drug-Resistant Organisms Management in Long Term Care Settings Workshop REGISTRATION FORM

The Infectious Disease Epidemiology Section will hold three, one-day workshops targeted towards infection preventionists who are employed by long term care facilities, acute care hospitals, and other healthcare settings throughout the state who have roles in infection surveillance and reporting. This workshop is meant to serve as a survey of skills and knowledge required to accurately and reliably perform the many duties required of infection prevention professionals in patient care settings. Individual sessions are aimed at identification and control of infectious agents and antibiotic stewardship.

The cities are: Metairie - Thursday, January 26, 2017; Lafayette- Tuesday, January 31, 2017; and Ruston – Tuesday, February 7, 2017. The training is free of charge, but attendees must register for each location (planning purposes for seating and handouts).

Name (…will appear on the certificate as printed here.)

Position Region

Work/Site Address

E-mail

Daytime Phone Fax

Location You Are Planning to Attend: o Metairie: East Bank Regional Library, 4747 West Napoleon Avenue, 70001

o Lafayette: Our Lady of Lourdes Regional Medical Center, 4801 Ambassador Caffery Parkway, 70508

o Ruston: Louisiana Tech University, 600 Dan Reneau Drive, 71270

Interested in Nurse Education Credits? Interested in Laboratory Education Credits?

o YES  YES

o NO  NO

Please email [email protected] or fax this registration form (email is preferred) to the Infectious Disease Epidemiology Section as soon as possible to the attention of Rosemarie Robertson, FAX (504) 568-8290. If you don’t get an email response from me within a few days, then I don’t have your registration. Any questions - email or call me at (504) 568-8310. I will be sending out additional/updated information to those who have sent in the registration forms.

Thank you!

This activity has been submitted to Louisiana State Nurses Association for approval to award contact hours. Louisiana State Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation

This activity has been submitted to Louisiana State Board of Medical Examiners for approval to award Laboratory contact hours.