Pacific Coast Fetal Cardiology 2017 - Case Submission Form

CHOC Children’s Presents
Pacific Coast Fetal Cardiology 2017

A Case-Based and Interactive Educational Symposium

April 28-29, 2017

Case Submission Form

You are invited to submit an interesting case in one or more of the following clinical areas:
·      Obstructive left heart lesions
·      Heterotaxy syndrome
·      Early fetal echocardiography
·      Variants of tetralogy of Fallot

Up to 12 clinical cases (3 per topic) will be selected based on overall interest as well as the role of fetal cardiovascular ultrasound imaging in diagnosis, clinical decision-making, and patient management.

Case submissions should include Clinical Presentation, Imaging Findings, and Summary and Discussion Points. For the submission process, the recommended number of slides is six, with a maximum of three video slides. We encourage submissions from sonographers, trainees, and junior staff.

During the symposium, presenters will be allowed six minutes, with as many or as few slides as desired. Each case will be followed by a question-and-answer period involving a panel of experts.

Case submission for Pacific Coast Fetal Cardiology 2017 is currently open at www.choc.org/fetalcardiology.

The submission deadline has been extended! New deadline is Friday, March 31, at 11:59 pm PST.

Each case presenter will receive a registration discount of $50. Additionally, 1st and 2nd place prizes will be awarded at the conference.

If you have any questions regarding the clinical case submission process, please contact Mary Hickcox at mhickcox@choc.org. Please email any support documents (less than 25mb) to mhickcox@choc.org.

Thank you!

Wyman W. Lai, MD, MPH, Program Director
Anita Moon-Grady, MD, Program Director

Question Title

* 1. Your Information:

First Name

Last Name

Liscense (MD, RN, etc)

Professional Title

Organization/Affiliation

Mailing Address

City

State

Zip

Phone

Question Title

* 2. Case Submission Title:

Question Title

* 3. Please select the clinical category for your case:

Question Title

* 4. Case Description:

After your case is submitted through this portal, please email additional files, photos, and videos that pertain to your submission to mhickcox@choc.org. If your files are over 25MB in total, please email mhickcox@choc.org for alternative instructions for uploading your files.

Thank you!