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Form Testing
Speaker Proposal Form
Use this form to submit your personal and presentation details to OCHCH.
About You
Name
(Required)
First
Last
Suffix / Credentials (ex: Ph.D., RN, MBA)
Enter text as you wish it to appear on event materials.
Email
(Required)
Enter Email
Confirm Email
Phone
LinkedIn (if available)
Work Title
(Required)
Organization
(Required)
Organization Website
Work Address
(Required)
Street Address
City
State / Province / Region
ZIP / Postal Code
Your Bio
Please provide a one-paragraph bio about you that is relevant to your presentation. Please limit the text to 150 words or less. This is intended for use in event marketing and attendee materials. OCHCH reserves the right to edit text for length. ** SKIP THIS if you are submitting multiple presentations and have already provided a bio. **
Upload Your Photo
Please upload a copy of your photo. High resolution images are preferred, but files at least 600 pixels on the smallest side are acceptable. All normal photo formats are accepted (ex: jpg, png, raw, tiff, hevc, etc). If you do not have an image now, we will follow up to obtain one ahead of the event. ** SKIP THIS if you are submitting multiple presentations and have already provided a photo. **
Max. file size: 15 MB.
About Your Presentation
OCHCH is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation, so it is necessary to have certain information made clear before we select content for events. Even if your content does not qualify for CE/CEU/CH hours, please complete the following to the best of your ability.
Presentation Title
Is this application for the 2024 Annual Confernce?
(Required)
Yes
No
If yes, the next question will provide a specific range of topic areas that align with our Call for Speakers. If not, our broader, annual calendar focus areas will be shown.
Focus Areas (Full Calendar)
(Required)
Select one or more focus areas that best match your presentation. Please choose carefully and do not over-select. These topic areas are essential for event attendees to know if your presentation is right for their interests. This will also help OCHCH plan for and market your contribution to our event.
Medicaid
Medicare Certified
Hospice
Private Duty
Billing and Coding
Legal
Payer Relations
Revenue Cycle Management
Rules and Regulations
Legal Estate Planning
Operations
Career and Personal Development
Industry Insights
Focus Areas (Annual Conference)
(Required)
Select one or more focus areas that best match your presentation. Please choose carefully and do not over-select. These topic areas are essential for event attendees to know if your presentation is right for their interests. This will also help OCHCH plan for and market your contribution to our event.
Clinical Care Delivery Models
EVV
Finance & Operations
Leadership & Workforce
Medicaid, Medicaid Waiver, MyCare Ohio
Regulatory & Legal Affairs
Technology, AI, & Digital Health
Other
Learning Objectives
(Required)
Learning Objectives describe what participants should be able to do or know as a result of the learning experience. Many accrediting bodies require objectives to award CE/CU/CHs. The objective should be measurable. Example: "The student will be able to define a 'verb' and identify a verb in a sentence." OCHCH will use these to evaluate if the program met these objectives afterwards with our attendee feedback surveys. Please consider a minimum of 2 objectives. Use the + icon to add more, up to a total of 5.
Add
Remove
Presentation Type
(Required)
Clinical, related to patient care
Non-Clinical, i.e. leadership, communication, wellness, financial
Unsure, need to confer with OCHCH
Presentation Summary
Please provide a one-paragraph summary of the presentation. Please limit the text to 200 words or less. This is intended for use in event marketing and attendee materials. OCHCH reserves the right to edit text for length.
Presentation Files
If you have any documents you feel would be helpful for OCHCH to review, please include them here. Due to file size limits, only pdfs will be accepted. If you have larger files, or would like to provide a link to them instead, enter that in the "comments" field at the end of this form.
Accepted file types: pdf, Max. file size: 15 MB.
Attendee Certificates
Is this content intended to award attendees Continuing Education credits/units, Contact Hours, or other industry certificates?
Yes
No
Unsure, need to confer with OCHCH
What type of certificates?
CE
CEU
CH
Other
Explain "Other"
Is this content already approved by an accreditation organization? If so, enter the name here.
If yes, who should award the certificates to attendees?
I or my organization will award the certificates to attendees
I request that OCHCH award the certificates to attendees
I don’t know
Acknowledgements
Complete the following section to confirm you have read the material in this form, including applicable policies and procedures, and understand and agree to comply with the guidelines outlined. By submitting this electronic document you attest that the information you entered in this form is correct as of this date of submission.
Logistics & Registration
I understand and agree.
• I understand the format, location, timing, and agenda of the event is determined by OCHCH and am willing to be flexible to ensure attendees receive the best possible experience.
• I understand that if my program is selected by OCHCH, I will receive a complimentary registration to the event.
• I agree to provide an event-ready copy of my presentation to OCHCH at least 5 business days before the scheduled event time and if changes are made, I will provide a final copy to OCHCH as soon as possible.
• For in-person events, I agree to arrive at least 30 minutes ahead of the scheduled time of my presentation.
• For online events, I agree to log in to the webinar 15 minutes ahead of the scheduled time of my presentation.
Emergency Arrangements
(Required)
I understand and agree.
If an emergency arises and you are unable to perform your duties as a speaker, please contact OCHCH within 24 hours at our office: (614) 885-0434. In an emergency, to the extent possible, the speaker shall help arrange for a suitable substitute speaker to present on their behalf.
Content Requirements
(Required)
I understand and agree.
• I understand that if CEs/CEUs/CHs are to be awarded to attendees I may be asked to provide a bibliography of sources and other supporting information before the event is held.
• Recommendations for patient care in accredited continuing education must be based on current science, evidence, and clinical reasoning, while giving a fair and balanced view of diagnostic and therapeutic options.
• All scientific research referred to, reported, or used in accredited education in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection, analysis, and interpretation.
Although accredited continuing education is an appropriate place to discuss, debate, and explore new and evolving topics, these areas need to be clearly identified as such within the program and individual presentations. It is the responsibility of accredited providers to facilitate engagement with these topics without advocating for, or promoting, practices that are not, or not yet adequately based on current science, evidence, and clinical reasoning.
• Content cannot be included in accredited education if it advocates for unscientific approaches to diagnosis or therapy, or if the education promotes recommendations, treatment, or manners of practicing healthcare that are determined to have risks or dangers that outweigh the benefits or are known to be ineffective in the treatment of patients.
• These expectations are drawn from Standard 1 of the Standards for Integrity and Independence in Accredited Continuing Education. For more information, see accme.org/standards. If we can help you to understand and/or apply these strategies to your education, please contact us.
Content Sharing with Attendees
(Required)
Yes
No
When possible, OCHCH shares event presentations and recordings with attendees after an event has concluded, including with registered attendees that were not able to attend. Typically, event recordings are only available for 90 days after the event date. Do you give your consent to share your presentation(s), a recording of the event, and other relevant attendee materials such as handouts, with event attendees?
Advertising
(Required)
I understand and agree.
I agree to prepare a fair & balanced presentation that is objective & unbiased, scientifically rigorous, and evidence-based where possible. If presenting research funded by a commercial company, the information presented will be based on generally accepted scientific principles and methods and will not promote the commercial interest of the funding company. During my presentation, I will not engage in any type of promotional marketing or selling of any product or service without prior approval from OCHCH.
Financial Relationships Disclosure
(Required)
I understand and agree.
• OCHCH is accredited by the American Nurses Credentialing Center’s Commission on Accreditation. We appreciate your help in partnering with us to follow accreditation guidelines and help us create high-quality education that is independent of commercial interest/ineligible organization influence. To participate as a person who will be able to control the educational content of this activity, we ask that you disclose all financial relationships with any ineligible companies that you have had over the past 24 months.
• Ineligible companies are defined as those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. There is no minimum financial threshold; you must disclose all financial relationships, regardless of the amount, with ineligible companies. We ask you to disclose regardless of whether you view the financial relationships as relevant to the education. For more information on the Standards for Integrity and Independence in Accredited Continuing Education, please visit accme.org/standards.
• Examples of financial relationships include employee, researcher, consultant, advisor, speaker, independent contractor (including contracted research), royalties or patent beneficiary, executive role, and ownership interest. Individual stocks and stock options MUST be disclosed; diversified mutual funds do not need to be disclosed. Research funding from ineligible companies MUST be disclosed by the principal or named investigator even if that individual’s institution receives the research grant and manages the funds.
• Why do we collect this information? Since healthcare professionals serve as the trusted authorities when advising patients, they must protect their learning environment from industry influence to ensure they remain true to their ethical commitments. Many healthcare professionals have financial relationships with ineligible companies. By identifying and mitigating relevant financial relationships, we work together to create a protected space to learn, teach, and engage in scientific discourse, free from influence from organizations that may have an incentive to insert commercial bias into education.
• What are the next steps in this process? After we receive your disclosure information, we will review it to determine whether your financial relationships are relevant to the education. Please note: the identification of relevant financial relationships does not necessarily mean that you are unable to participate in the planning and implementation of this educational activity. Rather, the accreditation standards require that relevant financial relationships are mitigated before you assume your role in this activity.
• If you have questions about these expectations, please contact us at ochch@ochc.org or (614) 885-0434
Do you have any Financial Relationships to disclose?
(Required)
Yes
No
I don't know, please contact me.
Financial Relationship List
(Required)
Use the + icon on the right to add additional rows.
Ineligible Company Name
Nature of Financial Relationship
Add
Remove
No Financial Disclosure
(Required)
Nothing to disclose
• In the past 24 months, I have not had any financial relationships with any ineligible companies.
Other Comments or Information
Submission of this form expresses your consent to be contacted by OCHCH via the method(s) you provide for the purposes of this engagement as well as emails with news, event announcements, or other programmatic content. Please know that due to a high level of interest in participating in Council events, we are unable to accept every request to speak. We will be in touch soon. Thank you!