Vaccination Prescriptive Authority And

ALBUQUERQUE Vaccination Prescriptive Authority and Immunization Training Program For Pharmacists (4 Separate Courses Offered!)

Full Vaccination Certification Program – 12hrs. (8hrs. live & 4 home study) -$150 member/$370 non-member (Application-based training) (Non-member fee for full course includes NMPhA annual dues) Certification for anyone who has completed the APhA Immunization Program within the past 2 yrs. – 2hrs. live $40 member/$80 non-member (Knowledge-based training) Saturday, March 15, 2014 Saturday, May 31, 2014 Saturday, July 19, 2014 Saturday, September 6, 2014

SPACING IS LIMITED, SO CONFIRM YOUR SEAT TODAY! The charge for the complete 12hr. training certification will be $150 for NMPhA & NMSHP Members and $370 for Non-Members (includes NMPhA annual Dues) or if your organization sends 10 or more, please contact NMPhA for group discount. ➋Anyone who has completed the APhA Immunization training course and wants prescriptive authority for New Mexico, must complete 2hrs. of childhood vaccination updates and review New Mexico laws and protocols. The fee for this 2hr. training is $40 for NMPhA Members and $80 for Non-Members in which the participant must have proof of their APhA participation as well as current CPR status. These 2 hours DO NOT MEET the requirement for BOP required live CE following certification. This training program will meet the requirements for a Certificate from the New Mexico Pharmacists Association for Pharmacist Vaccination Prescribing Authority. This is the approved training program required by regulations approved by the Board of Medicine, the Board of Nursing and the Board of Pharmacy.

The “Train the Trainer” program is complimentary for anyone who has previously completed the 12hr. course and is willing to commit to help NMPhA in teaching future training sessions. Please contact the NMPhA office directly if you are interested. Training requirement: Part 1: Home study component of 4 hours Part 2: Classroom component of 8 hours  You must complete the home study component prior to the classroom component.  You must demonstrate current LIVE CPR certification before the Pharmacist Prescriptive Authority Certificate is issued.  You MUST COMPLETE the combined 12 contact hours (1.2 CEU’s). No partial credit will be given.  You must score a passing grade on the program exams. Complete the attached registration form to sign up for the training. This program date will be limited, so send in your registration as soon as possible.

Purpose: This application-based program will provide education and training to assist pharmacists in implementing a successful immunization practice including pharmacist prescribing of vaccinations. Objectives: Following completion of this program, participants will understand: 1) Clinical information – a) Mechanisms of action, b) Standards for prescribing, c) Indications and Contraindications, d) Patient Evaluation, Assessment and Counseling, e) Vaccination for adolescents through adulthood, f) Recommendations and schedules for childhood and adult vaccines, g) Summary of Rules for vaccines, and h) After the shots; 2) Vaccine Information Statements – a) Legal Requirements and b) Detailed review of all vaccines; 3) ACIP Recommendations; 4) Practice Management – a) Storage Handling, b) Screening, c) Needle Tips and d) Immunization Facts; 5) Record Requirements – a) Record Card, b) DOH and Primary Care Provider, c) VAERS form, d) Release Forms, e) Insurance, f) Pharmaceutical Care Services and g) HCFA; 6) Appropriate use and compliance with the Prescribing Vaccine protocol as approved by the New Mexico Board of Pharmacy, the New Mexico Board of Medical Examiners and the New Mexico Board of Nursing; 7) Resources – a) Order Forms, b) Educational Materials, c) Multi-Lingual Products and d) Manufacturer Information. REGISTRATION FORM (3/15/14; 5/31/14; 7/19/14 or 9/6/14) Registration Fees: (please check program you will be attending) “Pharmacists Prescribing Vaccines – The New Mexico Program” “Pharmacists Prescribing Vaccines – The New Mexico Program Home-study requirements” ACPE #0104-0000-11-047-L01-P 8 contact hrs./0.8 CEUs/ Initial Release Date: 8/6/11 ACPE #0104-0000-11-046-H04-P 4 contact hrs./0.4 CEUs /Initial Release Date: 8/6/11 $150-NMPhA & NMSHP Members: Full 12 hrs.

$370-Non-Member: Full 12 hrs. (Non-member fee for full course includes NMPhA annual dues) “Childhood Immunizations & Pharmacist Prescribing Law” (1pm – 3pm) ACPE #0104-0000-13-054-L04-P Initial Release Date: 9/19/13 $40 2hrs.-NMPhA & NMSHP Member (completed the APhA course within the past 2 years)

$80 Non-Member: (completed the APhA course within the past 2 years) Michel Disco, MBA, RPh, Assistant Dean for External Programs, UNM College of Pharmacy, Albuquerque, NM Amy Bachyrycz, PharmD, Walgreen’s Patient Care Center Clinical Pharmacy Specialist; Clinical Assistant Professor, UNM College of Pharmacy, Albuquerque, NM Registration Includes: Instructions for Home Study portion and complete materials for classroom. 8am – 5pm… Lunch will be provided. The program will be held at the UNM College of Pharmacy, 2502 Marble Ave NE , Room #135, 8710 6 . Payment is required in advance. Please register at least 10 days prior to the scheduled program date in order to receive the home study materials in plenty of time! In case the program you have registered for is rescheduled or cancelled, you will be entitled to a full refund. Also, if you need to cancel and wish to receive a full refund, you must cancel at least 72 hours prior to the event. If 72hours notice is not provided, a $50 administrative fee will be charged. (Please circle date you plan to attend) (3/15/14; 5/31/14; 7/19/14 or 9/6/14) (Please circle one) Check Credit Card: Visa Master Card AMEX Discover Diners Club Make Checks Payable to NMPhA Ch# ______Amount ($): ______Date Mailed: ______Credit Card # ______Expiration Date: ______Security Code:______Credit Card Billing Address:______Signature ______RPh, PharmD: ______Name: (Print Clearly) ______Profession: (R.Ph., CPhT, etc.)______NABP e-Profile ID:______DOB (MMDD)______Employer :______(www.MyCPEmonitor.net to obtain ID #) Mailing Address: ______(where you wish your home-study materials be mailed) City: ______State:______Zip:______Home Phone: ______Work Phone: ______Fax: ______E-Mail: ______Fax Registration to: (505) 255-8476 Mail Registration to: New Mexico Pharmacists Association 2716 San Pedro NE, Suite C, Albuquerque, New Mexico 87110 Call in Registration: (505) 265-8729 or (800) 464-8729 The New Mexico Pharmacists Association is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. The ACPE Universal Activity Number that has been assigned for the 8.0/0.8 CEUs Live offering is #0104-0000-11-047-L01-P & the UAN assigned for the 4./0.4 CEUs Home-Study offering is #0104-0000-11-046- H04-P. The ACPE UAN for the 8.0/0.8CEUs ‘Train the Trainer’ program is #0104-0000-12-012-L01-P and for the 2.0/0.2 CEU’s ‘Childhood Immunizations & Pharmacist Prescribing Law’ is #0104-0000-13-054-L04-P. NMPhA will input the CPE credits into the CPE Monitor Database within 60 days based on the information provided on evaluation form.