2020 CMHC West Case Submission Form
PURPOSE
Submit a complex patient case that deals with the challenges of treating several cardiometabolic comorbidities simultaneously, including hypertension, obesity, type 2 diabetes, chronic kidney disease, dyslipidemia, heart failure, and ASCVD. Submitted cases will be presented during the Complexities in Cardiometabolic Care Summit at 2020 CMHC West

LIVE DISCUSSION FORMAT
2-4 patient cases will be discussed by a multidisciplinary expert panel (please see the Agenda for more details at https://www.cardiometabolichealth.org/2020/agenda-west.html)

WHY SHOULD I SUBMIT A CASE?
-You will get the chance to present your case on-stage if your case is selected
-A unique opportunity to interact with our expert panel and get their feedback and guidance on your most perplexing clinical case questions

SUBMISSION DEADLINE
March 6, 2020

*Fields in bold are required.
Email address *
First and Last Name *
Your answer
Phone *
Your answer
Degree *
Your answer
Specialty *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
For your patient case to be considered, please provide the following details:

Word Count Limit to: 1,000 words

Note: There is no limit to the number of patient cases you may submit. Submission is free.

Disease state (i.e. hypercholesterolemia, type 2 diabetes, obesity, hypertension, etc.) or current medical history/symptoms/reason for visit

Patient case introduction including:
- Past medical history, and/or family/social history
- Current Medications
- Exams/Lab Results
- 2-3 Questions To Pose To the Expert Panel For Discussion

IMPORTANT NOTE: Please do not include patient name, social security number, medical identification number, or any information specific to the patient's identity.
Your Case Details *
Your answer
Thank you for your submission. You will be notified by March 27, 2020 if your case is selected.
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