Case Presentation Submission Form
Association of Ringside Physicians Annual Conference
October 26-28, 2018
Las Vegas, NV

The purpose of this form is to provide an efficient Case Presentation submission process. Case reviewer will be blinded to authors’ names and affiliated institutions.

Abstract
Lead Author's First Name *
Your answer
Lead Author's Last Name *
Your answer
Lead Author's Affiliated Institution or Practice *
Your answer
Lead Author's Mailing Address *
Your answer
Lead Author's City *
Your answer
Lead Author's State *
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Lead Author's Zip Code *
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Lead Author's Country *
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Lead Author's Phone Number *
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Lead Author's Email Address *
Your answer
Additional Author (1)
Your answer
Additional Author (2)
Your answer
Additional Author (3)
Your answer
Date of Submission *
MM
/
DD
/
YYYY
Please complete the body of the case using the following key headings. All fields must be completed. The case must be limited to 600 words, excluding headings.
Title *
Your answer
Authors *
Your answer
Setting (Pre-bout, Intra-bout, Post-bout) *
Your answer
History *
Your answer
Physical Exam (if applicable)
Your answer
Tests & Results (if applicable)
Your answer
Final/Working Diagnosis *
Your answer
Treatment & Recommendations Did "the show go on?" *
Your answer
Outcome & Follow-up *
Your answer
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