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PCSS-BUPRENORPHINE

The PCSS is designed to assist physicians incorporate the use of buprenorphine for prescription opioid and heroin dependent patients into their practices. The PCSS service is available, at no cost, to interested physicians and staff. The essential elements of the PCSS are a national network of trained physician mentors with expertise in buprenorphine treatment and skilled in clinical education, who can provide support by phone or email. If you would like to receive support from the PCSS, please complete and submit this electronic form.

You may also download a copy of the registration form. Once completed, please email or fax it to PCSSproject@asam.org, fax: 301-576-5156, or call the PCSS toll-free line 1-877-630-8812 for further information.

1. First name:

2. Last name:

3. Email address:

4. Phone number:

5. Do you have a particular mentor you wish to work with?
(See below for a full list of PCSS Mentors, their specialties and locations.)

     choose mentor :

Mentor Specialty Location
Dan Alford
Gavin Bart Internal Medicine MN
Jeff Baxter Family Practice Doctors MA
John Brooklyn Family Practice Doctors VT
Anthony Dekker Family Practice Doctors AZ
egan egan Other NY
Ramsey Farah Addiction Medicine MD
David Fiellin
James Finch Family Practice Doctors NC
Michael Fingerhood Internal Medicine MD
Adam Gordon Internal Medicine PA
Howard Heit Pain Management VA
John Hopper Internal Medicine MI
Mark Jorrisch Internal Medicine KY
Mark Krauss Internal Medicine CT
Judy Martin
Brian McCarroll Addiction Medicine MI
Mary McMasters Addiction Medicine VA
Joe Merrill Internal Medicine WA
Karen Miotto
William Morrone Pain Management MI
Ted Parran
Edwin Salsitz Addiction Medicine NY
Andrew Saxon
Randy Seewald Internal Medicine NY
Laurene Spencer Internal Medicine CA
Trusandra Taylor Internal Medicine OR
NYAM TEST Other NY
Alex Walley Internal Medicine MA
Charles Walton Addiction Medicine UT
Susan Whitley Psychiatrist NY
George Woody Addiction Medicine PA
William Yarborough Internal Medicine OK




6. What city and state do you practice in?


7. What is your ZIP code?


8. What is your specialty?


9. Do you prefer a mentor with your same specialty even if that person is out of state (note: N/A if you've already chosen a mentor from the list above)?


10. What is your practice setting (e.g. private, clinic, academic, HMO, specialty addiction)?


11. How did you hear about the PCSS (e.g. Buprenorphine course, website, article, brochure):




You may also download a copy of the registration form. Once completed, please email or fax it to PCSSproject@asam.org, fax: 301-576-5156, or call the PCSS toll-free line 1-877-630-8812 for further information.

 

© 2005 New York Academy of Medicine

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