Advocate Children’s Hospital

Advocate Children's Hospital

Your Information
Which ECHO(s) would you like to register for:*
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Organizations Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Participants Name*
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Email*
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Credentials*
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Please select which device(s) you will be using to participate in ECHO Autism:*
- Tablet (iPad or Surface)
- Laptop/Desktop computer
- Polycom device
Please check the box below to confirm your acknowledgement and consent to participate as a community partner for the ECHO Autism project. I agree to:*
I agree to the terms below
Participate collegially in regularly scheduled ECHO Autism conferences by presenting cases, providing comments and asking questions; Provide clinical updates and de-identified outcome data on patients as needed; Keep confidential any patient information provided by other community partners during a conference; Complete periodic surveys to help improve services to clinicians and other partners; Use required software including, but not limited to Zoom and Box; Be solely responsible for the treatment of your patients and understand that all clinical decisions rest with you regardless of recommendations provided by other ECHO Autism participants and; Ensure that your patients are aware of your participation in ECHO Autism and their de-identified information could be shared. Be photographed and recorded during ECHO Autism sessions.

Advocate Children's Hospital

Your Information

Bringing the Best Autism Care to Local Communities