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UD PCS Summer Dental Symposium 2015

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Dodd Dental Laboratories University of Delaware, Professional & Continuing Studies

CONTINUING DENTAL EDUCATION

SUMMER SYMPOSIUM July 27–31, 2015 Ocean City, Maryland Clarion Resort Fontainebleau Hotel


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The Continuing Dental Education Summer Symposium combines quality education with a great location. If you are a general dentist, dental hygienist or dental assistant, take advantage of this continuing education program in a relaxed, collegial environment. Whether you are traveling alone or with family, Ocean City offers the ideal location for our Summer Symposium. Attractions abound, from the world-famous boardwalk, to the beautiful beaches (including nearby Assateague Island National Seashore); great shopping; tennis, golf and other recreational opportunities; arcades and amusements; and a nearly endless variety of restaurants and eateries. For more information on attractions and activities, go to www.ococean.com. Ocean City is approximately a three-hour drive from Baltimore, Philadelphia or Washington, DC. Excellent programs and speakers. Great beach location! Credit Participants will be awarded 4.0 credit hours for each seminar (except for the Mid-Atlantic P.A.N.D.A seminar, which awards 2.0 credit hours). To receive credit, participants must sign in at the seminar, attend the seminar in its entirety and complete an evaluation. Certificates of attendance will be awarded at the completion of each seminar and must be picked up at that time. Please contact your state examining board to see if the courses offered at this symposium are approved for credit. National Dentex Corporation is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing education programs of this program provider are accepted by AGD for Fellowship, Mastership, and membership maintenance credits. Approval does not imply acceptance by a state provincial board of dentistry or AGD endorsement. The current term of approval extends from 10/1/2014 to 9/30/2017. Provider ID# 211838 This continuing education activity has been planned and implemented in accordance with the standards of the ADA Continuing Education Recognition Program (ADA CERP) through joint efforts between National Dentex and University of Delaware.


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Program Schedule Monday, July 27

7:30 a.m. Registration and Continental Breakfast 8 a.m.–noon Clinical Nutrition in the Dental Practice: A Course Which Will Help the Dentist, Dental Staff, Families and Patients Along the Road to Optimal Health Thomas E. Baldwin, DDS, MAGD

Tuesday, July 28

7:30 a.m. Registration and Continental Breakfast 8 a.m.–10 a.m. Mid-Atlantic P.A.N.D.A. – Preventing Abuse and Neglect Through Dental Awareness Suzanne Kim, DDS 8 a.m.–noon The Complexities and Complications Associated With Restoring Dental Implants Carl F. Driscoll, DMD

Wednesday, July 29 7:30 a.m. Registration and Continental Breakfast 8 a.m.–noon Everything You Wanted to Know About Street Drugs But Were Afraid to Ask Harold L. Crossley, DDS, PhD Thursday, July 30

7:30 a.m. Registration and Continental Breakfast 8 a.m.–noon Infection Control is Not Optional: Dental Practitioners Need to be Involved Louis G. DePaola, DDS, MS

Friday, July 31

7:30 a.m. Registration and Continental Breakfast 8 a.m.–noon The Rapidly Evolving Field of Dental Sleep Medicine Elliott J. Alpher, BS, DDS Oliver C. Roberson, DC, CSHE David Gergen, CDT Congressman Marty Russo (retired)


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Monday, July 27, 8 a.m.–noon

Clinical Nutrition in the Dental Practice: A Course Which Will Help the Dentist, Dental Staff, Families and Patients Along the Road to Optimal Health Thomas E. Baldwin, DDS, MAGD An almost infinite number of sources tell us that optimal health and wellness are available to all of us. But no matter the source of this information, you have to be totally confused. There is conflicting information about how to attain optimal health, slow aging and have abundant energy. Dr. Baldwin will cut through the fog and give you information that you can use starting tomorrow. Attendees will learn to establish a plan for optimal health for themselves, their staff, their families and their patients. Learning objectives: • Learn the four pillars of optimal health • Learn how the four pillars relate to personal health • Learn how to formulate a plan to optimize personal health • Learn how to implement a plan for optimization of oral and total body health for patients This seminar is appropriate for dentists, dental hygienists and dental assistants. Dr. Baldwin graduated from the University of Maryland School of Dentistry in 1970. After serving for two years in the U.S. Army, he joined a practice as an associate dentist. He then taught full-time for two years at the dental school, during which time he opened a private practice in general dentistry in Towson, Maryland in 1975. He received a master of science in nutrition from the Clayton College of Natural Health in 2005. He has been awarded a mastership in the Academy of General Dentistry along with fellowship and accreditation from the International Academy of Oral Medicine and Toxicology. Dr. Baldwin retired from active dentistry in 2008 and now practices nutritional counseling and mentoring in dental practices.


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Tuesday, July 28, 8 a.m.–10 a.m.

Mid-Atlantic P.A.N.D.A.—Preventing Abuse and Neglect Through Dental Awareness Suzanne Kim, DDS Mid-Atlantic Preventing Abuse and Neglect through Dental Awareness (P.A.N.D.A.) is a continuing education course designed to educate dentists, dental hygienists, dental assistants and others about the problems of child abuse and neglect, domestic violence, elder abuse and neglect, and human trafficking. This course aims to teach dental and other health care professionals to recognize the indicators of abuse and neglect and inform them of their legal and ethical responsibilities in reporting and referring victims. Abuse and neglect are an ever-increasing problem in today’s society. Dental professionals are frequently the first health care professional to render treatment to a maltreated individual, yet make few reports. The more education you receive, the more likely you are to recognize and report. Early recognition with timely reporting and referrals to appropriate agencies can help prevent more significant health consequences and even death in maltreated individuals. Upon completion of this continuing education course participants will be able to: • Discuss the background of abuse and neglect, events of historical significance, and the effects of maltreatment of children, adults and the elderly. • Define, identify facts, and discuss child abuse and neglect, domestic violence, vulnerable adults, elder abuse and neglect, and human trafficking. • Describe the health care provider’s role and ethical and legal responsibility in reporting suspicious cases of maltreatment of children and vulnerable adults. • Identify the problem of abuse and neglect from a dental health perspective. • Identify local and national agencies to contact to appropriately report suspicious cases of maltreatment of children and vulnerable adults.


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• Describe the health care provider’s role in recognizing, reporting and referring victims of domestic violence, elder abuse and neglect, and human trafficking. • Discuss risk factors, indicators, screening questions, barriers to seeking help and education needed regarding abuse and neglect of children, domestic partners, vulnerable adults, elders and victims of human trafficking. This seminar is appropriate for dentists, dental hygenists and dental assistants. Dr. Suzanne Kim graduated in 1990 from Columbia School of Dental Medicine with a DDS degree. She has been in private practice since 1995 in Bethesda, Maryland. Dr. Kim has been teaching P.A.N.D.A. for about five years and has been involved with the local chamber of commerce, Rotary, churches and different study clubs. She has done pro bono work in Vietnam, Equador and in New Orleans, Louisiana after hurricane Katrina.

Tuesday, July 28, 8 a.m.–noon

The Complexities and Complications Associated with Restoring Dental Implants Carl F. Driscoll, DMD The implant industry continues to grow at an astounding rate. Once reserved only for patients with unlimited financial capabilities, patients of even moderate means are now receiving implant treatment. This presentation will focus on the complexities and complications that may be seen during the course of this treatment. These complications may actually be normal maintenance procedures that need to be identified prior to the start date of any proposed treatment and conveyed to the patient. A clear picture of preventable and non-preventable complications will be discussed. Attendees will be exposed to many different complications involving implant treatment through numerous clinical examples. The handling of these complications will be discussed so that the attendee can better treat his/her patients when unfortunate events dictate immediate reconciliation.


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Learning objectives: • Learn the complications that you may face with implants in your practice • Learn methods to differentiate implant complications that are normal maintenance issues from those that are not predictable • Learn clinical techniques to make implant treatment less stressful to you and the patient • Learn methods to deal with implant complications This presentation is appropriate for general dentists, prosthodontists, periodontists, oral and maxillofacial surgeons, hygienists and assistants. Dr. Carl F. Driscoll received his DMD from Tufts University in 1977. He completed a general practice residency at Ft. Meade, Maryland in 1978 and received his prosthodontic training at Letterman Army Medical Center in San Francisco in 1986. In 1990, he completed a fellowship in maxillofacial prosthetics at the National Naval Dental School in Bethesda, Maryland. Dr. Driscoll currently serves as a professor at the University of Maryland Dental School and as director of the prosthodontic residency. He previously held the same position with the United States Army at Walter Reed Army Medical Center in Washington, DC from 1994-1997. Dr. Driscoll retired from the U.S. Army in 1997 with the rank of colonel. Dr. Driscoll is a diplomate of the American Board of Prosthodontics and a fellow of the American College of Prosthodontists. Dr. Driscoll is vice president of the American Board of Prosthodontics and vice president of the American Academy of Fixed Prosthodontics. Dr. Driscoll has given over 225 presentations nationally and internationally, including in Sweden, Brazil, Germany, Korea, Japan, Singapore, Poland, Israel, Mexico, Canada, Brazil, Uruguay and the Marshall Islands. He has authored over 60 papers, abstracts and book chapters.


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Wednesday, July 29, 8 a.m.–noon

Everything You Wanted to Know About Street Drugs But Were Afraid to Ask Harold L. Crossley, DDS, PhD What questions should I be asking my patients to avoid drug interactions with street drugs? What are some of the oral manifestations of street drug abuse? How will I know if a person is under the influence of street drugs? What are the characteristics of and how do I manage the “doctor shopper”? Do I have to take any precautions with the dental patient who is under the influence? Why is it so important that the dental staff be knowledgeable about street drugs? Why am I at risk? What are some characteristics of adolescent substance abuse and what do I do about it? What if I know my teenager is abusing drugs? The dental team is in a unique position providing dental care to a patient population that may be regular users or experimenting with mood altering drugs. This dynamic, brutally honest, and graphic presentation will provide you with the information to be better prepared to encounter patients, family members and friends who are abusing street drugs or prescription medications. Discussion includes the origins, types, signs and symptoms of commonly abused prescription and illicit drugs. Learn: • The signs and symptoms of commonly abused prescription and illicit drugs in patients and adolescents • What medications to avoid with the suspected drug abusing patient • How to recognize and manage the doctor shopper • How to manage the recovering chemically-dependent patient • What are “meth mouth,” “lean,” “whippets,” “parachuting,” “bath salts,” “Spice Diamond,” “Spice Gold” and more? • How does my kid get intoxicated on hand sanitizer? This seminar is appropriate for dentists, dental hygienists and dental assistants.


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Harold L. Crossley, DDS, PhD is professor emeritus at the University of Maryland Dental School. A native of Rhode Island, Dr. Crossley received a bachelor of science in pharmacy from the University of Rhode Island in 1964. He later was awarded master of science (1970) and doctoral degrees (1972) in pharmacology. The University of Maryland Dental School in Baltimore awarded Dr. Crossley his DDS in 1980. His role as liaison between the classroom and his dental practice produced a practical approach to understanding the pharmacology of drugs used in the dental office. Dr. Crossley has co-authored a number of articles and four books dealing with a variety of topics within the field of pharmacology. Other areas of expertise include the pharmacology of street drugs and chemical dependency. Dr. Crossley serves on the Maryland State Dental Association’s Well-Being Committee, was a member of the University Interdisciplinary Committee for Drug Abuse Education and served on the Governor’s Commission on Prescription Drug Abuse. He is an active member of Phi Kappa Phi, Omicron Kappa Upsilon Honorary Dental Society, the American College of Dentists and the International College of Dentists. He has been a consultant for the United States Drug Enforcement Administration and other law enforcement agencies since 1974. Drawing on this unique background, Dr. Crossley has become nationally and internationally recognized as an expert on street drugs and chemical dependency as well as the clinical pharmacology of dental drugs.


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Thursday, July 30, 8 a.m.–noon

Infection Control Is Not Optional: Dental Practitioners Need to be Involved Louis G. DePaola, DDS, MS Learn what’s new in infection control. In May 2011, the CDC reaffirmed the importance of infection control with the release of the Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care, which is an update of the Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007 and Guideline for Disinfection and Sterilization in Healthcare Facilities 2008. Included in these documents are recommendations for updating of standard precautions and there are significant modifications that impact the delivery of health care. The alarming increase in antimicrobial resistance and health care associated infections (HAIs) compels all health care providers to be knowledgeable about infection control practices that reduce the risk of disease transmission. A thorough review of these new CDC Guidelines as well as the Guideline for Infection Control in Dentistry, 2003 and other current CDC/OSHA infection control recommendations will be presented. Recent spread of Ebola virus has caused concern for all health care workers. This presentation will review both Ebola and pandemic influenza, and discuss what steps oral health providers should take to reduce the potential of transmission in the dental office, as well as lessons to be learned from recent infection control breaches in Colorado, Oklahoma and Pennsylvania. This program will help the oral care provider to: • Understand the routes of transmission of infectious diseases and how to break the chain of infection. • Know the updated recommendations for standard precautions. • Learn the principles of respiratory etiquette to reduce the impact of colds and flu. • Learn how to develop a practical and cost effective infection control methodology to safely treat patients infected with resistant and blood


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borne diseases, achieve a safe workplace and comply with the most current CDC/OSHA recommendations. • Review the latest on these topics: principles of infection control, hard surface disinfection, instrument preparation and packaging, disinfection and sterilization, operatory set up and breakdown, personal protective equipment, dental unit waterlines, and post-exposure monitoring, follow-up and prophylaxis. This seminar is appropriate for dentists, dental hygienists and dental assistants. Dr. Louis DePaola is the assistant dean of clinical affairs and professor, Department of Oncology and Diagnostic Sciences, School of Dentistry, University of Maryland, Baltimore. He received his DDS in 1975, completed a master’s degree in oral biology, is a diplomate of the American Board of Oral Medicine and the American College of Dentists, and has a certificate in prosthodontics. He is the director for dental training for the PA-Mid-Atlantic AIDS Education and Training Center and served as a member of the ADA Council of Scientific Affairs from 2002-2005. Well known on the lecture circuit, he has presented at most major national meetings as well as numerous international organizations. Active in research, he has authored and co-authored over 130 journal articles, book chapters and abstracts and serves as a consultant to the American Dental Association and numerous other professional groups and private industry. Over the past 20 years, he has been awarded over 75 research and service grants, many in the field of antiplaque chemotherapeutic agents, HIV/AIDS, management of medically compromised dental patients, rapid salivary diagnostic testing, dental unit waterlines and infection control.


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Friday, July 31, 8 a.m.–noon

The Rapidly Evolving Field of Dental Sleep Medicine Elliott J. Alpher, BS, DDS Oliver C. Roberson, DC, CSHE David Gergen, CDT Congressman Marty Russo (retired) The rapidly evolving field of dental sleep medicine can be daunting to the dentist, given the variety of appliances, techniques and protocols available. A thorough understanding of the causes of sleep disorders, how patients develop their presenting symptoms and the relationship between the temporomandibular joint and the cervical spine is necessary for successful treatment. In this lecture, the unique relationship of the temporomandibular joint, the cervical spine and the autonomic nervous system will be examined from both a dental sleep medicine and atlas orthogonist perspective. Protocols for examination, diagnosis, fabrication of the appropriate appliance, delivering the appliance and titrating it for maximum effectiveness and home testing are all individual techniques honed by applying learned skills. Accepted science and the proper protocols based on a thorough knowledge of temporomandibular joint disorders, cervical spine anatomy, autonomic nervous system influences on the physiology of sleep and wakefulness and the unique properties of the selected appliance will allow for greater success. After this lecture, you will evaluate your patients more effectively. Knowing this field is rapidly evolving, you will learn what the federal government is doing about sleep issues and how the community needs to get involved. Dentists need to be part of the solution and not part of the problem and let their voices be heard. Participants will learn • The effect of an oral sleep appliance on the biomechanics of the entire body, the temporomandibular joints, the cervical spine and the biochemistry of sleep. • The connection between the jaw and cervical spine and how misalign-


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ment affects the jaw, neck and outcomes of oral sleep appliance therapy in dental sleep medicine. • How to create a reasonable treatment protocol and titrate sleep appliances. • Learn what the federal government is doing about sleep issues and how you can be part of the solution and not part of the problem. This seminar is appropriate for dentists, dental hygienists and dental assistants. Dr. Elliott Alpher, one of Washington, D.C.’s most experienced specialists for sleep and jaw disorders, on staff at George Washington University and Georgetown University Hospitals, has been known as a leader in the treatment of sleep disorders and jaw pain for 25 years. He has pioneered a conservative, noninvasive approach utilizing computerized and verifiable diagnostic methods to treat TMJ, snoring and sleep apnea. Alpher was also recently responsible for heading a delegation to the Federal Motor Carrier Safety Administration (FMCSA) and Medical Advisory Board (MAB) to introduce the new technology of compliance chips in oral appliances to treat and monitor sleep apnea and snoring of truckers and other transportation personnel. In addition, he earned the status of diplomate of the American Board of Craniofacial Pain and Dental Sleep Medicine in October 2013 and board member and diplomate of the Board of the American Sleep and Breathing Academy in March 2014. Dr. Alpher earned his bachelor of science in biology from the University of Maryland and his doctorate of dental surgery from Georgetown University Dental School. He completed a residency program at Providence Hospital and postgraduate studies in oral pathology and periodontics at the Walter Reed Army Institute of Research. Dr. Oliver Roberson began his professional career in the U.S. Naval Nuclear Submarine service in mechanical engineering and weapons maintenance, after 10 years transitioning into a health care career. He believed that his engineering background would assist him and be useful in understanding the complexities of the human body. Dr. Roberson is a cum laude graduate of Life University College of Chiropractic in Atlanta, Georgia and Excelsior University in New York. Initially specializing in sacral occipital technique (SOT), Dr. Roberson has since devoted years of post-graduate study to atlas orthogonal procedures, ergonomics assessment, clinical biomechanics,


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rehabilitation, sports injuries and somatic muscle re-education. Roberson is a member of the American Chiropractic Association, American Academy of Spine Physicians, American College of Sports Medicine and Academy of Spinal Biomechanics and Rehabilitation. He treats and specializes in numerous sports-related injuries as well as upper cervical specific conditions, sleep apnea, TMJ disorder, myofascial pain, headaches and chronic pain. Dr. David Gergen is the president of Pro Player Health Alliance and owner and operator of Gergen’s Orthodontic Lab in Phoenix, Arizona. He started his lab in 1986 and has grown it into one of the most respected labs in the country employing over 40 people. One of his proudest achievements is receiving the National Leadership Award for Arizona Small Businessman of the Year in 2004. Since receiving the award for Finest Orthodontic Technician in the country given by Columbus Dental in 1986, he has worked for some of the pioneers in the orthodontic and sleep dentistry fields. He was the personal technician for Dr. Harold Gelb, Dr. Robert Ricketts, Dr. Ronald Roth, Dr. A. Paul Serrano, Dr. Clark Jones, Dr. Arthur Gaus, Dr. Joseph R. Cohen and Dr. Edward Spiegel. He has also taught orthodontic technicians at Arizona Institute of Technology for dental and medical careers and has been active on the Arizona State University Sports and Medicine team since 1991. In 2012 he received a lifetime achievement award by the Gelb Academy as America’s greatest orthodontic technician of all time. Marty Russo earned his BA and JD from DePaul University, and has a lifetime of experience in the hallways of the U.S. Congress. A Chicago native, he was first elected to the U.S. House of Representatives at age thirty, going on to represent the 3rd District of Illinois for nine terms. An energetic advocate for good government, Russo developed a wide range of friendships on both sides of the political aisle and was known for his deep understanding of the legislative process and strategies for success, serving on key House committees including Ways and Means, Budget, Steering and Policy, Energy and Commerce, Small Business, Judiciary, and as a member of House Democratic leadership (Floor Whip). After leaving Congress, Russo served as CEO of one of the premier government relations firms, representing hundreds of nonprofits, corporations and associations. Currently he is a successful entrepreneur and an active speaker and lecturer on leadership topics.


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General Information Location

Registration

Clarion Resort Fontainebleau Hotel 10100 Coastal Highway Ocean City, Maryland 21842-2698

Online—To pay with a credit card or check, please visit www.udel.edu/dental.

The Clarion Resort Fontainebleau Hotel is located between 100th Street and Old Landing Road in Ocean City, Maryland. Look for the Clarion Hotel sign on the ocean side. Conference Parking Ample free parking is available surrounding the hotel. Additional free parking is located across the street. Both parking lots have “Clarion Hotel” signs. Accommodations The Clarion Resort Fontainebleau Hotel is one of Ocean City’s finest full-service hotels. Located directly on the beach overlooking the Atlantic Ocean, the Clarion offers the ultimate in comfort. In addition to the standard accommodations, the hotel also provides room service; free weekday newspapers; gift shop; beauty shops; bellman; in-room microwaves, refrigerators and safes; two ocean-front restaurants; nightclub; live entertainment both inside and on the beach; fitness center and sauna; heated indoor and outdoor pools. This hotel is close to area attractions and outlet shopping. The Ocean City airport is only nine miles from the hotel. The Clarion is a convenient drive from Baltimore, Washington, D.C., Philadelphia and New York. A limited number of rooms have been reserved at a special reduced room rate. Interested participants should contact the hotel directly at 800-638-2100 and ask for the Summer Dental Symposium group rate. Reservations must be made by June 29, 2015. For more information about the hotel, visit www.clarionoc.com.

Fax—To pay by credit card, purchase order or government voucher, fax form on the next page to 302-831-0701. Phone—Have your credit card and course information ready, then call 302-831-7600, weekdays. Mail—Please see form on the next page. You can also download the registration form at www.udel.edu/dental. Price Symposium registration weekly rate is $750 for dentists and $375 for dental hygienists or other team members. The daily rate is $225 for dentists and $100 for dental hygienists or other team members. The P.A.N.D.A. course is $150 for dentists and $75 for dental hygenists or other team members. The registration fee includes seminar instruction, course materials, certificates of attendance and continental breakfast each day. Participants assume responsibility for living accommodations and all other meals. Refund Policy A full refund will be given for written cancellations received before July 20, 2015. No refunds will be given after this date. The University of Delaware is not responsible for any cancellation or change fees assessed by airlines or travel agencies. For More Information If you have any questions about this conference, please call 302-831-3474, or write to lmalbone@udel.edu.


Registration Form

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Continuing Dental Education Summer Symposium n Mr. n Ms. n Dr.

July 27–31, 2015

Name ____________________________________________Degree____________________ Name as you would like on your name badge ______________________________________ Email address ________________________________________________________________ Employer __________________________________________________________________ Home address ______________________________________________________________ City ________________________________State ____________Zip __________________ Telephone __________________________________________________________________ How did you hear about the symposium? n Postcard n AGD website n DCEdental Newsletter n NJ Dental Association Journal n Virginia Dental Association website

n Email n Web search n Word of mouth n Other (please specify) _____________________________________

Symposium Registration Fee—Full payment is due with registration. Please indicate the program(s) you wish to attend. If you are registering for the week, please select the Tuesday seminar you wish to attend. Dental Hygienist/Team Member rate: Dentist rate: n Weekly ......................................$750 ............(200-001) n Weekly ......................................$375 ............(200-002) n Mon. (Nutrition) ....................$225 ............(201-001) n Mon. (Nutrition) ....................$100 ............(201-002) n Tues. (P.A.N.D.A.) ....................$150 ............(202-001) n Tues. (P.A.N.D.A.) ....................$75 ..............(202-002) n Tues. (Implants)......................$225 ............(202-003) n Tues. (Implants)......................$100 ............(202-004) n Wed. (Street Drugs) ..............$225 ............(203-001) n Wed. (Street Drugs) ..............$100 ............(203-002) n Thurs. (Infection Control) ..$225 ............(204-001) n Thurs. (Infection Control) ..$100 ............ (204-002) n Fri. (Sleep Medicine) ............$225 ............(205-001) n Fri. (Sleep Medicine) ............$100 ............(205-002) Enclosed is my check for $ ____________ made payable to the University of Delaware. When you provide a check as payment, you authorize us either to use the information from your check to make a one-time electronic funds transfer from your account or to process the account as a check transaction.

Please charge $ ________ to my

n Visa n MasterCard n American Express n Discover

Card No. _______________________________________________ Exp. Date ____________ Security Code (on back of card) ___________________ Authorized Signature __________________________________________________________ Return to: Continuing Dental Education Summer Symposium, University of Delaware Division of Professional and Continuing Studies, 201 John M. Clayton Hall, Newark, DE 19716-7410 Attn: Registrar Phone: 302-831-7600, Fax: 302-831-0701 Registrants are responsible for all fees unless written cancellation is received by July 20, 2015. Please duplicate form for additional enrollments.


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