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Maternal, Child, and Adolescent Health

   
CONFERENCE REGISTRATION FORM - 2013 INTIMATE PARTNER VIOLENCE/DOMESTIC VIOLENCE * Required Fields

Participants will learn about the "cycle of violence," steps for screening a patient involved in IPV, review mandatory domestic violence reporting laws, and understand the clinic's legal responsibilities. The class also reviews brain development of exposure to chronic violence, how to document domestic violence on the patient's care plan, and resources available for patients in domestic violence relationships.

LOCATION: Superior Court Building
600 S. Commonwealth Ave
8th Floor, Conference Room B
Los Angeles, CA 90005

Prerequisite: None
Intended Audience: All staff providing direct patient care and program oversight (including mid-level practitioners, supervisors and managers)

CONTACT: Christian Murillo At (213-639-6419) Or cmurillo@ph.lacounty.gov

Participant Information
* First name:
* Last name:
* Position Title:
* Work Organization:
* Street1:
Street2:
* City: State:  Zip: 
* Phone:   Fax:  (e.g.999-999-9999)
* Email:
* Immediate Supervisor's Name:

* Please select 1 next to the class that you would like to attend
2013 Intimate Partner Violence/Domestic Violence: Friday, May 17th, 2013 8:00 AM - 12:30 PM
2013 Intimate Partner Violence/Domestic Violence: Monday, June 24th, 2013 8:00 AM - 12:30 PM
2013 Intimate Partner Violence/Domestic Violence: Tuesday, September 17th 12:00 PM - 4:30 PM
2013 Intimate Partner Violence/Domestic Violence: Wednesday, December 4th 12:00 PM - 4:30 PM

* I have received my supervisor's approval to attend the marked session(s):
* I am available to attend any of the sessions I have marked above.
  

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