2023 Case Management Summit Hotel Requests and Breakout Sessions

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Thank you for your interest in the 2023 Virginia Ryan White Case Management Summit. You will use this survey to:

Provide information about your role in case management
Request hotel accommodations (if needed)
Let us know of any dietary restrictions and ADA needs
Select your breakout session
Enter CEU information (if needed)

Please make sure you complete every field of this survey.

Incomplete surveys are not able to be processed.

Please note: Completion of this survey does not guarantee acceptance into the summit or hotel accommodations. All registrations and accommodation requests will be reviewed by summit staff and funders. Accepted participants will be notified by email by February 10, 2023 of their breakout session and hotel confirmation (if accommodations were requested). Additionally, this program is strictly limited to participants providing HIV case management (Ryan White and HOPWA) or similar services supporting people with HIV in Virginia and is not open to nurses, social workers, or case managers in other fields, consumers (unless they work in an HIV case management position), or the general public. Thank you.

Case managers coming from more than 25 miles away may request a hotel room to be provided at no cost on the evening of March 2. Rooms are limited and may sell out before the deadline listed below, so register early.

IMPORTANT: THE DEADLINE TO REQUEST HOTEL ACCOMMODATIONS IS:

FRIDAY, JANUARY 27TH, 2023

If you have questions about hotel accomodations please contact Ryan Persaud at ryan.persaud@vcuhealth.org.

First Name

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Last Name

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Agency Name

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What is your work email address?

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What is your work phone number with area code?

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What is your job title?

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Based on your job title/role, which table would be most appropriate to assign you to during our networking activities.

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To the best of your recollection, please list each agency, position, and number of years/months in each position you've held where you've provided HIV case management (Ryan White or HOPWA)

If you're not a case manager (or previously a case manager) simply enter "N/A"

Example:
Medical Case Manager and HOPWA Case Manager at AIDS Services Group: 3 years and 2 months
Medical Case Manager at UVA 3 years and 6 months
Case Management Supervisor at UVA 2 years and 1 month
My total years providing case management is: 8 years, 9 months

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For confirmation, please enter your total number of years and months providing HIV case management ( Ryan White or HOPWA)

(Example: 6 years, 3 months)

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Hotel Accommodations:

Hotel accommodations are available for those traveling more than 25 miles, under the following guidelines:

The cost of this room will be covered by VDH. However, incidentals, room services charges, damage to the room, etc will be your responsibility.
You will be required to provide a credit or debit card at check in to cover incidentals.
If you request a room and then do no attend without giving us at least 7 days' notice, you / your agency will be charged the state rate for that room.
If you bring a family member with you, you will be responsible for the dual occupancy charge in your room.

By signing below and selecting "yes," to the following question, you are confirming your understanding and agreement of these conditions.

Are you requesting a room be reserved for you at the Hilton Short Pump Hotel and Spa on Thursday, March 2, 2023?

(Reminder: only those whose work location is more than 25 miles away are eligible for a room)

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Yes No

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Please sign here attesting that you agree to the conditions of hotel accommodations.

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Add signature

Do you need ADA accessible accommodations?

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Yes No

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If yes, please provide information about accommodations you are requesting.

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Do you have any dietary restrictions? (Select all that apply)

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I do not have any dietary restrictions

Vegetarian

Vegan

Lactose Intolerant

Gluten Free

No Shellfish

No Nuts

No Pork

Other (please specify)

If "Other," please describe.

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Please select your top choice of breakout session.

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Housing is Healthcare

Achieving Health Equity for Immigrants and Refugees

Building Staff and Client Retention

1st Year Case Management Survival Guide

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Please select your second choice of breakout session.

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Housing is Healthcare

Achieving Health Equity for Immigrants and Refugees

Building Staff and Client Retention

1st Year Case Management Survival Guide

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Certificate of Attendance and Continuing Education Units

In the next section, you wil indicate if you would like a general certificate of attendance or continuing education units. The event has been accredited through VCU Health for both social work and nursing credits. Individuals requesting CEUs will need to provide additional information and attend the entire conference as this event has not been approved for partial credits. If you have questions about the CEU process, please email ryan.persaud@vcuhealth.org

Accreditation:

In support of improving patient care, VCU Health Continuing Education is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), and the Association of Social Work Boards (ASWB) to provide continuing education for the healthcare team.

Note: This program is only funded to provide CEUs for Nurses or Social Workers directly funded by Ryan White or HOPWA programs.

Social Work: As a Jointly Accredited Organization, VCU Health Continuing Education is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. Regulatory boards are the final authority on courses accepted for continuing education credit. Social workers completing this course receive 11.5 continuing education credits.

Nursing: VCU Health Continuing Education designates this activity for a maximum of 11.5 ANCC contact hours. Nurses should claim only the credit commensurate with the extent of their participation in the activity.

What type of certificate are you requesting

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As indicated above, this event is not approved for partial credits. Attendance for the entirety of each session is required for CEUs. Those requesting CEUs will be "signed in" and "signed out" of each session. You will then need to turn your signature sheet into event staff at the end of the summit to be submitted for CEUs.

At the end of the summit all individuals requesting CEUs will also be required to complete a program evaluation with questions requested from the accrediting body.

Please sign below to confirm your understanding of these requirements.

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Add signature

Please list your degree applicable to the CEU being requested (BSN, BSW, MSN, MSW, etc)

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Please provide your legal name and the complete mailing address where you would like documentation of your CEUs to be mailed.

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Please make sure you complete every field of this survey.

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IMPORTANT: THE DEADLINE TO REQUEST HOTEL ACCOMMODATIONS IS:

FRIDAY, JANUARY 27TH, 2023

Case Management Years of Service Celebration

Hotel Accommodations:

Breakout Sessions

Certificate of Attendance and Continuing Education Units

You have selected an option that triggers this survey to end right now.