OTP ECHO Registration Form

Information about Project ECHO:

Project ECHO is owned by the Regents of the University of New Mexico (UNM), the rights to which have been assigned or licensed to the University of New Mexico Health Sciences Center (UNMHSC). Project ECHO communities track their growth and activities within the iECHO database.

This is a non-contractual agreement outlining the roles and responsibilities between the MACS TeleECHO Clinic and any learning partner participating in our TeleECHO Clinic.

As part of this agreement, MACS will:
Provide best practice tools and tele-mentoring through case-based learning TeleECHO Clinic sessions.

Each 60-minute MACS TeleECHO Clinic will include the following:
-A brief lecture
-Case presentation
-Q & A
-Patient recommendations

As a learning partner, I agree to:

- Complete the pre and post-assessments
- Participate in each of 60-minute MACS TeleECHO Clinic case-based learning sessions, using a virtual meeting platform
- Submit de-identified case(s) and present them to the group during TeleECHO clinics

I understand that:

- Project ECHO case consultations do not create or otherwise establish a provider-patient relationship between any ECHO clinician and any patient whose case is being presented in a TeleECHO clinic session.
- While the case consultations and TeleECHO clinic sessions may offer recommendations regarding effective evaluation, care, and treatment options, these represent recommendations only.
- The patient's treating provider retains sole responsibility for selecting and implementing the plan for evaluation, care, and treatment of the patient.