The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

Yeve6Q3XysquspPE5FZW7FTEnqMdIU3vFVR5cAxYdt6EiCh8UXwRIICJ5Z4SFJcAegSmYp2iaC2I

OUD ECHO Survey A: Fellowship Application

Returning?

A A A

This program is designed to train Illinois primary care providers (physicians, nurse practitioners, and physician assistants) in the assessment and treatment of opioid use disorders in their clinical settings. The training will provide not only clinical guidance but also technical support around the clinical workflows, policies, and protocols to ensure compliance with clinical standards and evidence-based practice. Upon full completion, each participant will receive a certificate and approximately 40 hours of continuing education credits.

Fellowship Components Include:

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

Cohort 9: June 24-25, 2023

Cohort 10: April 13-14, 2024

Cohort 11: July 12, 2025

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

Cohort 9: 7/25/23-3/5/24

Cohort 10: 5/21/24-11/12/24

Cohort 11: 7/29/25-1/27/26 (see schedule here)

Please fill out the application completely.

Cohort 11 Application Deadline: 6/20/25

Last Name

* must provide value

First Name

* must provide value

Credentials

* must provide value

MD/DO (Physicians)

DNP/ANP/FNP (Nurse Practitioners/APRNs)

PA (Physician Assistant)

Other

reset

Other

Email Address

* must provide value

Phone Number

* must provide value

Discipline or Specialty (Select your primary field)

* must provide value

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

Psychiatry or Mental Health Provider

Addiction or Substance Use Treatment Provider

reset

Name of your PRIMARY practice location

* must provide value

Five-digit zip code of your PRIMARY practice location

* must provide value

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

* must provide value

Yes

reset

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.

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

* must provide value

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

reset

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.