This order form may be printed and returned by mail or fax to AMDA:
| American Medical Directors Association 11000 Broken Land Parkway, Suite 400 Columbia, MD 21044 |
Fax Number: 410-740-4572 |
| Item Number |
Program Title |
Member Price |
Non- member Price | Quantity Ordered |
Cost | ||||||||||||||||
| Books and Print Materials | |||||||||||||||||||||
| CPT3 | Guide to CPT Coding, Reimbursement and Documentation in Long Term Care | Unavail | Unavail | _______ | _______ | ||||||||||||||||
| DC1 | Recommendations for Completing Death Certificates | $15.00 | $20.00 | _______ | _______ | ||||||||||||||||
| MODEL | AMDA Model Medical Director Agreement and Supplemental Materials: Medical Director of a Nursing Facility | $25.00 | $25.00 | _______ | _______ | ||||||||||||||||
| PROT1 | Protocols for Physician Notification: Assessing and Collecting Data on Nursing Facility Patients - A Guide for Nurses on Effective Communication with Physicians | $20.00 | $30.00 | _______ | _______ | ||||||||||||||||
| SYN1 | Synopsis of Federal Regulations in the Nursing Facility: Implications for Attending Physicians and Medical Directors | $20.00 | $30.00 | _______ | _______ | ||||||||||||||||
| CMD | |||||||||||||||||||||
| Please note: these products are only available to CMDs | |||||||||||||||||||||
| CMD-Decals | CMD Decals | $5.00 | _______ | _______ | |||||||||||||||||
| CMD-Cert | Duplicate CMD Certificates | $25.00 | _______ | _______ | |||||||||||||||||
| Teaching Kits | |||||||||||||||||||||
| LTCPCC1_PC1 | Palliative Care Tool Kit with Teaching Kit | $225.00 | $275.00 | _______ | _______ | ||||||||||||||||
| LTC Tool Kits | |||||||||||||||||||||
| LTCPC1 | Palliative Care in the Long-Term Care Setting | $50.00 | $75.00 | _______ | _______ | ||||||||||||||||
| LTCANT1 | Antithrombotic Therapy in Long-Term Care Setting | $110.00 | $150.00 | _______ | _______ | ||||||||||||||||
| LTCIMM2 | Immunization Tool Kit | $60.00 | $100.00 | _______ | _______ | ||||||||||||||||
| IMM-DVD | Immunization DVD | $25.00 | $50.00 | _______ | _______ | ||||||||||||||||
| LTCANE | Anemia in Long Term Care | $30.00 | $40.00 | _______ | _______ | ||||||||||||||||
| LTCINF1 | Infection Control: Focusing on Management of VRE and MRSA in the Long Term Care Setting UNAVAILABLE | $30.00 | $40.00 | _______ | _______ | ||||||||||||||||
| LTCMNR1 | Determination of Medical Necessity of Rehabilitation Therapy Services | $30.00 | $40.00 | _______ | _______ | ||||||||||||||||
| LTCSEIZ | Seizures in the Long-Term Care Setting | $30.00 | $40.00 | _______ | _______ | ||||||||||||||||
| TOOL1 | Tool Kit for Managing Attending Physicians | $50.00 | $65.00 | _______ | _______ | ||||||||||||||||
| CPG Implementation Tool Kits | |||||||||||||||||||||
| UTTK | Urinary Incontinence Implementation Tool Kit | $110.00 | $150.00 | _______ | _______ | ||||||||||||||||
| DemTK | Tool Kit for Implementation of the Clinical Practice Guideline for Dementia | $110.00 | $150.00 | _______ | _______ | ||||||||||||||||
| DepTK | Tool Kit for Implementation of the Clinical Practice Guideline for Depression | $110.00 | $150.00 | _______ | _______ | ||||||||||||||||
| Falls/OstTK | Tool Kit for Implementation of the Clinical Practice Guidelines for Falls & Osteoporosis | $110.00 | $150.00 | _______ | _______ | ||||||||||||||||
| CPGIMPKIT | We Care: Implementing Clinical Practice Guidelines Tool Kit | $100.00 | $150.00 | _______ | _______ | ||||||||||||||||
| ITKP | Tool Kit for Implementation of the Clinical Practice Guideline for Pain Management | $110.00 | $150.00 | _______ | _______ | ||||||||||||||||
| ITKPU | Tool Kit for Implementation of the Clinical Practice Guidelines for Pressure Ulcers | $110.00 | $150.00 | _______ | _______ | ||||||||||||||||
| CPG Handheld (PDA) Applications | |||||||||||||||||||||
| PC1 | PDA Application: Pain Management (PocketPC format) | $49.95 | $69.95 | _______ | _______ | ||||||||||||||||
| PC2 | PDA Application: Depression (PocketPC format) | $49.95 | $69.95 | _______ | _______ | ||||||||||||||||
| PC3 | PDA Application: Falls and Fall Risk (PocketPC format) | $49.95 | $69.95 | _______ | _______ | ||||||||||||||||
| PDA1 | PDA Application: Pain Management (Palm/PDA format) | $49.95 | $69.95 | _______ | _______ | ||||||||||||||||
| PDA2 | PDA Application: Depression (Palm/PDA format) | $49.95 | $69.95 | _______ | _______ | ||||||||||||||||
| PDA3 | PDA Application: Falls and Fall Risk (Palm/PDA format) | $49.95 | $69.95 | _______ | _______ | ||||||||||||||||
| Audio CD-ROMs | |||||||||||||||||||||
| AUD1 | Developing Policies Procedures for the Long Term Care Facility: The Medical Director's Role | $25.00 | $35.00 | _______ | _______ | ||||||||||||||||
| Clinical Practice Guidelines | |||||||||||||||||||||
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| CPGFULL | Complete Set of 23 CPGs below | $365.00 | $550.00 | _______ | _______ | ||||||||||||||||
| CPG17 | Acute Change of Condition in the Long Term Care Setting | $20.00 | $30.00 | _______ | _______ | ||||||||||||||||
| CPG14 | Altered Nutritional Status | $20.00 | $30.00 | _______ | _______ | ||||||||||||||||
| CPG24 | Anemia in the Long-Term Care Setting | $20.00 | $30.00 | _______ | _______ | ||||||||||||||||
| CPG19 | Common Infections in the Long Term Care Setting | $20.00 | $30.00 | _______ | _______ | CPG18 | COPD Management in the Long Term Care Setting | $20.00 | $30.00 | _______ | _______ | ||||||||||
| CPG13 | Dehydration and Fluid Maintenance | $20.00 | $30.00 | _______ | _______ | ||||||||||||||||
| CPG7A | New! Delirium & Acute Problematic Behavior | $20.00 | $30.00 | _______ | _______ | ||||||||||||||||
| CPG8 | Dementia | $20.00 | $30.00 | _______ | _______ | ||||||||||||||||
| CPG4 | Depression | $20.00 | $30.00 | _______ | _______ | ||||||||||||||||
| CPG15 | Diabetes Management in the Long Term Care Setting(Revised 2008) | $20.00 | $30.00 | _______ | _______ | ||||||||||||||||
| CPG9 | Falls and Fall Risk | $20.00 | $30.00 | _______ | _______ | ||||||||||||||||
| CPG22 | Gastrointestinal Disorders in the Long Term Care Setting | $20.00 | $30.00 | _______ | _______ | ||||||||||||||||
| CPGIMP | Guideline Implementation | $20.00 | $30.00 | _______ | _______ | ||||||||||||||||
| CPG23 | Health Maintenance in the Long-Term Care Setting | $20.00 | $30.00 | _______ | _______ | ||||||||||||||||
| CPG6 | Heart Failure | $20.00 | $30.00 | _______ | _______ | ||||||||||||||||
| CPG10 | Osteoporosis | $20.00 | $30.00 | _______ | _______ | ||||||||||||||||
| CPG11 | Pain Management in the Long Term Care Setting | $20.00 | $30.00 | _______ | _______ | ||||||||||||||||
| CPG16 | Parkinson's Disease | $20.00 | $30.00 | _______ | _______ | ||||||||||||||||
| CPG5 | Pharmacotherapy Companion to Depression | $20.00 | $30.00 | _______ | _______ | ||||||||||||||||
| CPG2-12 Updated! |
Pressure Ulcers in the LTC setting | $20.00 | $30.00 | _______ | _______ | ||||||||||||||||
| CPG21 | Sleep Disorders in the Long Term Care Setting | $20.00 | $30.00 | _______ | _______ | ||||||||||||||||
| CPG20 | Stroke Management and Prevention in the Long Term Care Setting | $20.00 | $30.00 | _______ | _______ | ||||||||||||||||
| CPG3 | Urinary Incontinence | $20.00 | $30.00 | _______ | _______ | ||||||||||||||||
| AMDA Apparel | |||||||||||||||||||||
| TS101 | Sweatshirt - Poly/Cotton blend sweatshirt with AMDA logo over the left breast | $25.00 | _______ | _______ | |||||||||||||||||
| S M L XL | |||||||||||||||||||||
| GS102 | Golf Shirt - 100% cotton shirt with AMDA logo over the left breast | $25.00 | _______ | _______ | |||||||||||||||||
| S M L XL | |||||||||||||||||||||
| LAB103 | Lab Coat - Poly/Cotton blend with AMDA logo above the left breast pocket | $25.00 | _______ | _______ | |||||||||||||||||
| S M L XL | |||||||||||||||||||||
Total Amount of Order $___________ |
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| Shipping Charge is based on Total Amount of Order. $20.00 or less add $6.00; $20.01 to $50.00 add $8.00; $50.01 to $100.00 add $11.00; $100.01 and up add $15.00 Shipping charges are for domestic orders only. For orders shipped outside the U.S., please call for shipping rates: +1(410)740-9743 |
Shipping Charge $___________ | ||||||||||||||||||||
| Total Amount Due $___________ | |||||||||||||||||||||
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Name ______________________________________________________________ Organization_________________________________________________________ Address ____________________________________________________________ Address Type: ____Residential ____Commercial City/State/Zip ________________________________________________________ Office Phone ( ____ )____________________ Fax ( ____ )____________________ E-mail:_____________________________________________________________ Form of Payment : Card number _____________________________________ Credit Card Expiration Date ______________ Name on Card ____________________________________ Security Code __________ Signature _______________________________________________________________ |
rev. 06/08