PACEP SA24 CPC/Keystone Case Submission

PACEP SA24 CPC/Keystone Case Submission

Please email alexandra.amducci@lvhn.org with any questions.
I want to be considered for these presentation options:*

Case CompetitionCPCBoth
Submission Date:*

MonthDayYear
Primary Presenter First Name:*
Primary Presenter Last Name:*
Primary Presenter Email*
example@example.com
Primary Presenter Cell Number*

Area CodePhone Number
Primary Presenter Credentials:*
Primary Presenter Institution:*
Primary Presenter ACEP Number:
Contact Information if submission is being completed by someone other than primary presenter.
Name, Email, Phone Number
If submitting for CPC Faculty Discussant
Name, Email, Phone Number

Please list ALL authors in order if the submission is being considered for the case competition. Do not forget to appropriately place the presenting author in this list.

	First Name	Last Name	Credentials	Level of Education/Training
Author:
Author:
Author:
Author:
Author:
Author:
Author:
Author:
Author:
Author:
Author:
Author:
Author:
Author:

Case Title
Please upload CPC and/or Case Competition file as a word or PDF File*

Browse Files
If selected, a PowerPoint presentation will be required for the conference. Cancelof
I certify that this case is fully HIPAA compliant.

If accepted, the primary presenter will present in-person at the conference as well as register for the conference.
Signature*
Should be Empty: