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OUD ECHO Survey A: Fellowship Application

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This program is designed to train Chicagoland primary care providers (physicians, nurse practitioners, and physician assistants) in the assessment and treatment of opioid use disorders in their clinical settings. [NOTE: If you practice in downstate Illinois counties (i.e., outside of Chicago/Chicagoland), please apply instead to Carle's fellowship program here.] The training will provide not only clinical guidance but also provide technical support around the clinical workflows, policies, and protocols to ensure compliance with clinical standards and evidence-based practice. Each participant will receive a certificate, approximately 40 hours of continuing education credits, and up to $2000 in training reimbursement* upon full completion.

Fellowship Components Include:

1. Online Weekend Immersion Course (Sat: 8:00-5:00, Sun: 8:45 - 3:30)

Cohort 8: September 10-11, 2022

Cohort 9: June 24-25, 2023

2. Weekly ECHO didactic/case webinars on Tuesdays, 12pm - 1pm

Cohort 8: 10/11/22 - 5/30/23 (see schedule here)

Cohort 9: 7/25/23-3/5/24 (see schedule here)

Please fill out the application completely.

Cohort 8 Application Deadline: 8/26/22

Cohort 9 Application Deadline: 5/31/23

*Reimbursement paid in four installments: $500 for completion of training weekend, $500 for attending at least twenty webinars, $500 for presenting a case of a patient for whom the fellow prescribed buprenorphine, and $500 for expanding practice to include at least five patients with OUD.

Last Name

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First Name

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Credentials

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MD/DO (Physicians)

DNP/ANP/FNP (Nurse Practitioners/APRNs)

PA (Physician Assistant)

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Email Address

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Phone Number

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Discipline or Specialty (Select your primary field)

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Primary Care Provider (Internal Medicine, Family Medicine, General Practice)

Psychiatry or Mental Health Provider

Addiction or Substance Use Treatment Provider

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Five-digit zip code of your PRIMARY practice location

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Do you treat patients who live in Illinois at your primary practice location?

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Yes

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This program is funded with money from the state of Illinois. Thus, participants must treat patients who are living in Illinois. You are thus not eligible to apply.

Is your primary practice located in Cook, Dupage or Lake County?

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Yes

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Given that you practice outside Chicago/Chicagoland, there is a parallel fellowship program offered at Carle Health which is tailored to the needs of Downstate Illinois providers. Please instead apply here.

Which of the following practice settings best describes the PRIMARY setting where you are currently prescribing buprenorphine or planning to prescribe buprenorphine?

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Community Health Center/FQHC/Rural Health Center

Emergency Department

Hospitalist/Inpatient Consult Team

Licensed Addiction Treatment Facility (licensed outpatient, residential, opioid treatment program)

Private Practice

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