![](media/image1.png){width="1.0597222222222222in"
height="1.0597222222222222in"}Nashville Area

OFFICE OF PUBLIC HEALTH

QUARTERLY NEWSLETTER

Volume I, Issue 1 January 2007

**[In this issue of the OPH Newsletter:]{.mark}**

[]{.mark}

[Click on the titles below to go directly to the articles.]{.mark}

[]{.mark}

[**[Welcome]{.mark}**](#Welcome) **[1]{.mark}**

**[[Health Education -- Traditional Role of Tobacco](#HealthEducation)
2-3]{.mark}**

**[[Public Health Matters -- Influenza Update](#PHMatters) 3]{.mark}**

**[[Substance Abuse -- Prenatal Substance Exposure](#SubstanceAbuse)
4]{.mark}**

**[[Health Promotion/Disease Prevention -- Youth Obesity](#HPDP)
5]{.mark}**

**[[Statistics -- Immunization Information System](#Statistics)
6]{.mark}**

**[[Behavioral Health -- A Multi-disciplinary
Approach](#BehavioralHealth) 7]{.mark}**

**[[Chief Medical Officer -- Pandemic Flu Preparation](#CMO) 8]{.mark}**

**[[Oral Health -- Dental Sealants](#OralHealth) 9]{.mark}**

**[[OFFICE OF PUBLIC HEALTH DIRECTORY](#Calendar) 10]{.mark}**

**[[Calendar of Events](#Calendar) 11]{.mark}**

[]{.mark}

[]{.mark}

**WELC**[]{#Welcome .anchor}**OME!**

In late December, we in the Nashville Area Office of Public Health began
to prepare our FY 2007 Work Plan, with the purpose being to reach out
and provide as many services and support as possible to all of the 27
Tribes/Nations that we service.

Among the many ideas we discussed, the newsletter was re-created to
provide one communication vehicle between our office and you. From what
I understand, a newsletter has been published by this office before, as
well as from USET, Inc., so this newest issue is merely a renewal of our
commitment to facilitate communications.

We hope that you will enjoy this issue of the newsletter, and if you do
have ideas on future topics, please let us know. The plan is to
electronically distribute this newsletter on a quarterly basis to both
Health Directors and Clinical Directors; please share it with others in
your facility.

We also want to provide all of you with the opportunity to provide
feedback to our office on the 2007 Work Plan. We will be sending out an
individual mailing in the coming weeks, as well as meeting with you at
the upcoming USET Impact Week in Arlington. However, if you wish to
provide your feedback to the 2007 Work Plan prior to these dates, please
send comments by e-mail to me or other OPH staff.

I look forward to meeting with all of you in the coming months, and
please don't hesitate to contact any of us in the Office of Public
Health should you need assistance.

Sincerely,

Tim Ricks, D.M.D., M.P.H.

Director, Office of Public Health

Nashville Area Indian Health Service

He[]{#HealthEducation .anchor}alth Education

Mary Wachacha, Lead Consultant, IHS Health Education

***Traditional Role of Tobacco***

The IHS recognizes that tobacco holds a traditional and sacred role for
many American Indian people and that role varies from tribe-to-tribe.
Tobacco is used by American Indians for many purposes including prayer,
offerings, gift-giving, & medicine. Prior to the use of commercial
tobacco, tobacco consisted of a blend of natural plants such as red
willow, mullein, & bearberry but today, the tobacco related health
problems American Indians/ Alaska Native people suffer are caused by the
chronic non-ceremonial use of commercial tobacco.

Commercial Tobacco use is considered the most preventable cause of death
in the United States and across Indian Country due to its direct
relationship with lung cancer, heart disease and stroke.

![](media/image3.wmf){width="5.002777777777778in"
height="3.745138888888889in"}

The billing for tobacco cessation services is dependent upon many
variables including the type of:

[Insurance]{.underline} - Billing is dependent upon insurance:

-   Center for Medicare and Medicaid Services (CMS)

    -   Medicare: Federally regulated

    -   Medicaid: State regulated

-   Private insurance

[Provider:]{.underline}

CMS Recognized Providers Providers not recognized by CMS

Physicians Pharmacists

Physician assistants Nurse

Nurse practitioners CAN, LPN

Nurse midwives Physical Therapists

Clinical psychologists Laboratory Technicians

Clinical social workers Others

[Facility:]{.underline} Billing is dependent on Facility Type:

**Type of Facility Method of Payment**

RHC/FQHS All-inclusive Rate (AIR) for the encounter

IHS/Tribally Owned/Operated hospital AIR

IHS/Tribally Owned/Operated non- Medicare Physician Fee Schedule (MPFS)

Hospital-based facility

[Intervention:]{.underline} There are 3 mechanisms of billing for
tobacco cessation services:

-   Group visits

-   Individual sessions

-   Sessions incorporated into a provider visit

[Documentation:]{.underline} Reimbursement is based upon correct
documentation:

-   Treatment

-   Education

-   Time

Public []{#PHMatters .anchor}Health Matters

Posted 12/15/06 by MPHD Mail, Approved by Jim Marshall, Immunization
Coordinator

![](media/image4.jpeg){width="2.2708333333333335in"
height="2.2708333333333335in"}

***Influenza Update***

> Influenza (Flu) season in the Nashville Area typically begins each
> year in mid-December and runs through March.
>
> According to the Centers for Disease Control and Prevention (CDC),
> influenza or flu-like symptoms include:

-   **Fever**

-   **Muscle aches**

-   **Headache**

-   **Extreme tiredness**

-   **Dry cough**

-   **Sore throat**

-   **Runny or stuffy nose**

The best protection against influenza is to get a flu shot every year.
The CDC says it is not too late to get a flu shot even after the start
of the flu season. Those who do not get a flu shot should consider the
following steps to prevent the spread of flu and cold germs this time of
year.

-   Cover your nose and mouth when coughing or sneezing, preferably
    using a disposable tissue.

-   Use tissues to contain respiratory secretions and dispose of them
    after use.

-   Wash hands (with soap and water or use an alcohol-based hand gel)
    often to remove germs.

-   Keep your hands away from face (especially mouth and eyes).

-   Be courteous to co-workers and classmates by staying at home if
    possible when you have flu-like symptoms.

Link to CDC flu website:
[[http://www.cdc.gov/flu/weekly/usmap.htm]{.underline}](http://www.cdc.gov/flu/weekly/usmap.htm)

Substanc[]{#SubstanceAbuse .anchor}e Abuse

Elizabeth Neptune, OPH Managed Care/Substance Abuse Consultant

![](media/image5.jpeg){width="1.2in" height="1.6847222222222222in"}

> ***Prenatal Substance Exposure:***
>
> ***An epidemic that is hurting the Next Generation***
>
> Native people across tribal affiliation have recognized the next
> generation as a sacred trust. Many native traditions think of planning
> for the future in terms of thinking about the implications for the
> seventh generation. However, reservations and communities across the
> country are being affected by the devastating implications of prenatal
> Substance exposure.

The number one cause of mental retardation in the country remains the
use of alcohol during pregnancy. Fetal Alcohol Spectrum Disorders are
now joined with other substances in affecting the well-being of the next
generation and may imperil the next seven generations unless we take a
protective informed stance. SAMHSA estimates that 148,000 infants born
in the United States have a history of intrauterine illicit drug
exposure. The number of children with FASD is unknown. It is thought
that one out of four children is born with exposure to alcohol. What we
do know is that it remains rampant and is a condition that affects a
child throughout their life time, Lupton, Burd and Harwood (2004)
estimate that the prevention of one case of FAS saves \$130,000 in
health and related costs in the first 5 years of the child's life.

Children born under the influence are at higher risk of being born
preterm and with smaller head circumferences and lower birth weights.
Depending on the substance they may need advance medical care.
Opiate-addicted babies may experience Neonatal Abstinence Syndrome
requiring extensive intervention in a neonatal intensive care unit where
the baby's substance withdrawal is managed. The impact of the drug use
depends on the amount of drug used during the pregnancy and the timing
of the use as well as other maternal factors.

The current rate of prenatal drug exposure makes it a major health
problem. It has both an immediate impact on newborns and long term
effects. In the United States the two most abused drugs are alcohol and
tobacco. Alcohol impairs and alters the development of the fetal brain
structure. It results in permanent damage and in large dosage is
associated with growth reduction, cognitive deficits and reduced growth
patterns (Fetal Alcohol Syndrome). Less obviously effected babies may
have reduced cognitive function and problems with social functioning.

Exposure to tobacco leads to premature birth and low birth weights and
irritability at birth. The irritable baby is at greater risk of having
problems with attachment and taxes parental abilities. Additionally,
tobacco exposed infants are more likely to have lower intelligence
scores and higher rate of attention deficit. Many substance exposed
children will have difficulties with attachment and increased medical
needs whether the culprit is alcohol, tobacco, cocaine, heroin, or
methamphetamine the developing brain of the child is effected.

If we are to make a difference in our communities we need to raise the
level of awareness of the threat of drug and alcohol exposure and we
need to be come active in the diagnosis of the effects of maternal drug
use so that we can intervene. Early intervention can change the course
and the outcome. It can not undo the damage but it can help the family
and the child deal with the issues and ramifications changing the
quality and outcome of a child's life.

Health Promo[]{#HPDP .anchor}tion/Disease Prevention

Michelle Ruslavage, B.S.N., R.N., C.D.E.

Area Nursing, CHR, and HP/DP Consultant

> ***Preventing Overweight and Obesity***
> ![](media/image6.wmf){width="2.0215277777777776in"
> height="1.4388888888888889in"}
>
> ***in our Native Youth***
>
> The Indian Health Service Division of Diabetes Treatment and
> Prevention (DDTP) has been collaborating with the DHHS Office of
> Women\'s Health (OWH) since late 2004 on adapting the general audience
> BodyWorks Toolkit for an American Indian/Alaska Native audience.

BodyWorks is a federal initiative developed by OWH to help prevent
overweight and obesity in adolescent girls by using a family-based
approach. The kit aims to help parents and caregivers of adolescent
girls make changes to improve the family\'s eating and activity habits.
The kit offers tools and action steps in addition to information about
nutrition and physical activity. Strategies also focus on school and
community support for adolescent girls and families.

Since that time, all toolkit components, except the DVD, have been
modified for an AI/AN audience. The last piece of the toolkit, the
girl\'s guide called 4teens, is undergoing DHHS clearance through USDA.
DDTP is developing a training and evaluation plan with the IHS Nutrition
and Dietetics Training Branch in Santa Fe and the IHS Health
Promotion/Disease Prevention (HP/DP) Program, with input from Health
Education and other IHS program staff.

It is anticipated, that once the AI/AN toolkit has undergone full DHHS
clearance, that the toolkits will be printed in early 2007. A train the
trainer session for 7 - 8 federal, tribal and urban Indian health pilot
sites and the IHS HP/DP Area Consultants will be held in March 2007 in
Albuquerque, NM. The evaluation will include data collected from the
lead program staff in each pilot site as well as program participants.
Sometime in FY 2008, after a report and review of the evaluation from
the pilot sites, and after any needed revisions based upon the pilot,
the program will be rolled out nationally.

Some toolkit components, the recipe book, the owner\'s guide and the
girl\'s guide, will be available for ordering from the DDTP on-line
resource catalog by late spring 2007. These items will be available for
communities not participating in the pilot, or who cannot implement the
full BodyWorks 10-week curriculum with support groups, but who may be
interested in using some of the toolkit components as stand-alone
pieces.

St[]{#Statistics .anchor}atistics, Epidemiology

Kristina Rogers, Area Statistician

![](media/image7.wmf){width="1.2708333333333333in"
height="1.3854166666666667in"}

***Immunization Information System (IIS)***

> Immunization Information System use has rapidly increased across the
> country since 1993. These computerized systems, previously known as
> Immunization Registries, are maintained by the American Academy of
> Pediatrics (AAP) to benefit children, pediatricians and communities.

They are responsible for approximately 56% of immunization records for
U.S. children ages 6 and older. In 2005, 75% of public vaccination
providers submitted vaccination data to the IIS and 44% of private
vaccination providers submitted vaccination data to the IIS. There are
currently 13 million children participating in the IIS. There is an
estimated 21 million more needed to ensure a 95% participation rate by
all U.S. children. These confidential electronic immunization records
can be accessed regionally or nationally with the development of
interstate agreements between states. Access to immunization records is
limited to those who have proper security clearance and credentials.
These individuals are able to track the immunizations of a child, in
turn decreasing the rate of over-immunized children in the U.S.

It is not known yet whether these immunization information systems
improve the rates of immunizations in children, but it is a tool that
can help immunization programs and health-care providers make more
informed decisions. Vaccine inventory management and routine public
health surveillance are just some of the functions of IIS. The system
can collect and combine vaccination data, generate reminder and recall
notifications, assess vaccination coverage within a distinct geographic
area and provide the opportunity for vaccine management, adverse event
reporting, lifespan vaccination histories and a link to other electronic
data sources.

**Indian Health Service (IHS) and Immunization Information Systems
(IIS)**

The Indian Health Service encourages the use of immunization registries
because they are an excellent way to keep track of childhood
immunizations. IIS collects quality data that can be used for
epidemiological and statistical research and reporting. They are helpful
in distinguishing populations that are at risk for disease and useful in
creating plans for managing infection and prevention during outbreaks.

The Indian Health Service Healthy People 2010 national Government
Performance and Results Act (GPRA) goal for childhood immunization is a
rate of 90%. Increasing the use of Immunization Information Systems and
the RPMS Immunization Package may help improve GPRA childhood
immunization rates and improve the health of American Indian/Alaska
Native people.

The mission of the Indian Health Service is "to raise the physical,
mental, social, and spiritual health of American Indians and Alaska
Natives to the highest level". Focusing on the prevention of disease
will improve the health of all people. Because children are the stepping
stones to culture, life and tradition, improving their health will help
ensure the health of American Indian/Alaska Native adults in the years
to come.

References:

[http://pediatrics.aappublications.org/cgi/content/full/118/3/1293]{.underline}.
PEDIATRICS Vol. 118 No. 3 September 2006, pp. 1293-1295
(doi:10.1542/peds.2006-1723)

[http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5549a3.htm?s_cid=mm5549a3_e%0d%0a](http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5549a3.htm?s_cid=mm5549a3_e%0D%0A).
MMWR WEEKLY. December 15, 2006 / 55(49);1327-1329. Immunization
Information Systems Progress \-\-- United States, 2005

<http://www.ihs.gov/PublicInfo/PublicAffairs/Welcome_Info/IHSintro.asp>.
Indian Health Service Introduction.

Beha[]{#BehavioralHealth .anchor}vioral Health

Palmeda Taylor, Ph.D., Area Behavioral Health Consultant

> ![](media/image8.wmf){width="1.6in" height="1.6in"}***Adopting an
> integrated, multidisciplinary approach to***

***health care could prove beneficial***

** **

> In a January 2006 *American Journal of Orthopsychiatry* (Volume 76,
> Number 1) study, Kruase et al set out to determine the feasibility of
> an approach, which would address the issue of the chronic and multiply
> comorbid, recurrent, intensive health care user.

The approach, as originally piloted in a community hospital in suburban
Chicago in 1998, utilized a multidisciplinary team (a primary nurse
advocate, a primary care physician, and a behavioral counselor) to
perform the following functions:

-   A comprehensive review of each participant's obtainable physical,
    social, and psychological health history and records and an
    extensive whole-person interdisiciplinary intake evaluation.

-   The development of measurable goals in a collaborative fashion,
    along with specified time frames and responsibilities (participant
    and team).

-   Face-to-face meetings with the team and the participant as well as
    periodic meetings with the participant's whole-person health program
    providers (e.g., a nutritionist, psychologist, financial counselor,
    massage therapist) and with the participant's significant others, as
    needed.

-   Participation and compliance tracking coordination of all health
    care, individual and group education, decision support, and
    coaching.

To determine the approach's effectiveness, researchers surveyed
high-cost utilizers with multiple chronic illnesses and psychological
and socioeconomic distresses from Midwest hospitals. They administered
survey instruments prior to the development of participants'
individualized treatment plans and again 1-year later. Team advocates
also completed a set of diagnostic measures on each participant.

Results indicated that enrollees of this multidisciplinary team advocacy
approach showed improvement in terms of: perceptions of physical
functioning, physical well-being, control, self-efficacy (the belief
that one can actively influence one's environment and circumstances
through personal actions), and life satisfaction. Additionally,
health-related behavior changes were reported, and short-term costs were
significantly lower than projected costs. Finally, the participants
rated their health care services in the program as more effective than
previous health care services.

**Conclusion**: It appears that health care systems would profit from
adopting an integrated, multidisciplinary, whole-person approach to
providing health care services to individuals with multiple chronic
conditions. The use of such an approach is consistent with both the
Native American health care philosophy of treating the "whole-person"
and implementation of Dr. Grim's Chronic Care Model.

Chie[]{#CMO .anchor}f Medical Officer

Roy Kennon, M.D., NAO Chief Medical Officer

[Reprinted]{.underline}

![](media/image9.wmf){width="1.1701388888888888in"
height="1.2138888888888888in"}***Pandemic Flu Preparedness***

> The following information is provided as a summary and review, for
> your convenience and ready access, regarding pandemic flu
> preparedness. However, please note that, \"\... many activities
> described in the Public Health Guidance for State and Local Partners
> are similar, if not the same as those required to combat other
> infectious diseases, such as Severe Acute Respiratory Syndrome (SARS)
> or intentionally-spread smallpox or plague.

Topics covered in the Public Health Guidance for State and Local
Partners may, therefore, be relevant to---or addressed in---other
emergency preparedness plans. (See, for example: Public Health Guidance
for Community-Level Preparedness and Response to SARS:
[www.cdc.gov/ncidod/sars/guidance/](http://www.cdc.gov/ncidod/sars/guidance/);
Smallpox Response Plan and Guidelines:
[www.bt.cdc.gov/agent/smallpox/response-plan/index.asp](http://www.bt.cdc.gov/agent/smallpox/response-plan/index.asp)).\"

**HHS Pandemic Influenza Plan**

Visit PandemicFlu.gov
([http://www.PandemicFlu.gov](http://www.PandemicFlu.gov/)) for one-stop
access to U.S. Government avian and pandemic flu information.

The HHS Pandemic Influenza Plan is a blueprint for pandemic influenza
preparation and response. It provides guidance to national, state, and
local policy makers and health departments. Please also recognize that
substantial benefits in preparedness for, and recovery from, many types
of natural and manmade disasters will result from pandemic flu planning
and preparedness.

The HHS Plan includes an overview of the threat of pandemic influenza, a
description of the relationship of this document to other Federal plans
and an outline of key roles and responsibilities during a pandemic. In
addition, it specifies needs and opportunities to build robust
preparedness for and response to pandemic influenza.

The HHS Plan has three parts. Part 1, the HHS Strategic Plan, outlines
federal plans and preparation for public health and medical support in
the event of a pandemic. Part 2, Public Health Guidance for State and
Local Partners, provides detailed guidance to state and local health
departments in 11 key areas. Part 3, which is currently under
development, will consist of HHS Agencies' Operational Plans

View and Print Entire Plan (PDF)
<http://www.hhs.gov/pandemicflu/plan/pdf/HHSPandemicInfluenzaPlan.pdf>

(396 pages, 6MB)

For an overview of Plan:
<http://www.hhs.gov/pandemicflu/plan/overview.html>  

(PDF Version <http://www.hhs.gov/pandemicflu/plan/pdf/Overview.pdf> - 18
pages, 618KB)

Part 1 -- HHS Strategic Plan
<http://www.hhs.gov/pandemicflu/plan/part1.html>

(PDF Version <http://www.hhs.gov/pandemicflu/plan/pdf/part1.pdf> - 28
pages, 613MB)

Part 2 -- Public Health Guidance for State and Local Partners
<http://www.hhs.gov/pandemicflu/plan/part2.html>

(PDF Version <http://www.hhs.gov/pandemicflu/plan/pdf/part2.pdf> - 20
pages, 1MB)

Last revised: March 30, 2006

Ora[]{#OralHealth .anchor}l Health Update

Tim Ricks, D.M.D., M.P.H., Area Dental Officer

![](media/image10.wmf){width="1.3020833333333333in" height="1.125in"}

> ***Dental Sealants:***
>
> ***Effective Decay Prevention in Children AND Adults***

Dental sealants were first approved by the American Dental Association
in 1972.^1^ Overwhelming research has demonstrated the efficacy of
dental sealants in reducing dental caries (tooth decay), especially in
children but not exclusively in children.

Many dentists in the public health community have advocated for the use
of "universal sealants," a term given to the application of dental
sealants on both children and adults based on caries risk rather than
potential third party payor reimbursements. In fact, the lack of dental
insurance coverage has been cited as one of the major factors in the
slow acceptance of dental sealants by dentists in private practice.^2^

However, data suggest that dental providers should consider placing more
dental sealants on primary and permanent teeth in children and permanent
teeth in adults. According to the 1999 Oral Health Survey of American
Indian and Alaska Native Dental Patients^3^, the Nashville Area has a
large proportion of both children and adults with a history of dental
caries (tooth decay):

-   In children 2-5 years of age, 79.7% had a history of dental caries
    or active caries

-   In children 6-14 years of age, 62.4% had a history of dental caries
    or active caries

-   In adolescents 15-19 years of age, 97.7% had a history of dental
    caries or active caries

-   In adults 35-44 years of age, 68.7% had active, untreated decay

-   In elders 55 years of age and older, 44.7% had active, untreated
    decay

What these rates demonstrate is that Native Americans in the Nashville
Area, as well as throughout the Indian Health Service, continue to
experience dental decay at rates significantly higher than the national
average among non-Native Americans. Consequently, the application of
dental sealants based upon caries risk may *significantly* reduce the
caries burden of the populations we serve.

Last (GPRA) year, the Nashville Area provided 7,802 sealants to our
patients. While this reflected an increase from the previous year when
6,748 sealants were applied, it was still slightly lower than the GPRA
goal of 8,496. The goal in the current year should remain at 8,496, and
dental providers are encouraged to embrace -- through their own research
and education -- the idea of evidence-based sealant applications.

It may be noted that some dentists may use restoration codes instead of
sealant codes on certain procedures. For example, a preventive resin
restoration (PRR), a restoration that often involves a fissurotomy to
remove incipient decay, should be coded as a dental sealant (ADA code
1351) **[if dentin is not penetrated during the procedure]{.underline}**
(the delivery of anesthesia and the type of material -- unfilled or
filled resin -- is irrelevant to the coding).

^1^ American Dental Association, Council on Dental Materials and
Devices. Nuva-Seal pit and fissure sealant classified as provisionally
accepted. J Dent Assoc 1972; 84:1109.

^2^ Burt, B. A., and Eklund, S.A. [Dentistry, Dental Practice, and the
Community: 5^th^ Edition]{.underline}. W.B. Saunders 1999; 26:334.

^3^ Indian Health Service Division of Oral Health, Department of Health
and Human Services. An Oral Health Survey of American Indian and Alaska
Native Dental Patients: Findings, Regional Differences, and National
Comparisons. Department of Health and Human Services, 1999.

OFFICE OF PUBLIC HEALTH

DIRECTORY -- 2007

711 Stewarts Ferry Pike

Nashville, TN 37214

\(615\) 467-1500

Fax: (615) 467-1585

**OPH Director/Area Dental Officer/**

**Chronic Care & Electronic Health Record Contact**

Dr. Tim Ricks

Office: **615-467-1508**

Cell: **615-519-5099**

**Behavioral Health Consultant/Urban Programs Coordinator**

Dr. Palmeda Taylor

Office: **615-467-1534**

Cell: **615-519-6319**

**Health Promotion/Disease Prevention Coordinator/**

**Area Nursing Consultant/Area CHR Consultant**

Michelle Ruslavage

Office: **615-467-1628**

Cell: **615-519-3821**

**Area Statistician/GPRA Coordinator**

Kristina Rogers

Office: **615-467-2926**

**Clerical Support**

Rhonda Mattern

Office: **615-467-1567**

**Clerical Support**

Charlene Billie

Office: **615-467-1600**

**Area/IHS Elder Care Consultant/IHS Chronic Care Lead**

Dr. Bruce Finke

Cell: **615-417-4915**

**Area/IHS Health Education Consultant**

Mary Wachacha

Cell: **828-292-1175**

**Area Managed Care/Substance Abuse Consultant (acting)**

Elizabeth Neptune

Cell: **207-214-6524**

**Area Managed Care Consultant (detailed to EHR)/EHR Contact**

Deborah Burkybile

Cell: **615-519-6320**

[]{#Calendar .anchor}\
OFFICE OF PUBLIC HEALTH

Calendar of Events

+-----------+-----------------------------+-------------+--------------+
| **Date**  | **Event**                   | *           | *            |
|           |                             | *Location** | *Attending** |
+-----------+-----------------------------+-------------+--------------+
| **Jan. 23 | Education in Palliative and | Window      | Dr. Palmeda  |
| -- 25,    | End-of-Life Care for        | Rock,       | Taylor       |
| 2007**    | Oncology Patients           | Arizona     |              |
|           |                             |             | Dr. Bruce    |
|           |                             |             | Finke        |
+-----------+-----------------------------+-------------+--------------+
| **Jan. 23 | National Nurses Leadership  | Rockville,  | Michelle     |
| -- 26,**  | Council                     | Maryland    | Ruslavage    |
|           |                             |             |              |
| **2007**  |                             |             |              |
+-----------+-----------------------------+-------------+--------------+
| **Jan. 23 | DMS RPMS TRAINING           | NAO         | Kristina     |
| -- 24,**  |                             |             | Rogers       |
|           |                             |             |              |
| **2007**  |                             |             |              |
+-----------+-----------------------------+-------------+--------------+
| **Jan.    | Nashville Area Dental Call  | 86          | Dr. Tim      |
| 24,**     | 11-12 CT                    | 6-766-7230; | Ricks        |
|           |                             | Passcod     |              |
| **2007**  | (all dental programs        | e--6920488# | (Call        |
|           | invited)                    |             | Leader)      |
+-----------+-----------------------------+-------------+--------------+
| **Jan.    | IHS Open Door Forum         | 8           | Mary         |
| 25,**     | 11-12:30 CT                 | 88-455-6771 | Wachacha     |
|           |                             |             |              |
| **2007**  | (all facilities invited,    | Pass        | (NAO Leader) |
|           | Nashville Area is being     | c           |              |
|           | highlighted)                | ode-4860154 | Dr. Tim      |
|           |                             |             | Ricks        |
+-----------+-----------------------------+-------------+--------------+
| **Jan. 27 | DATA TRANSMISSIONS ARE DUE  | ** **       |              |
| -- Feb.1, | AT AREA OFFICE              |             |              |
| 2007**    |                             |             |              |
+-----------+-----------------------------+-------------+--------------+
| **Jan. 29 | HP/DP, Nursing, CHR Site    | St. Regis   | Michelle     |
| -- 31,**  | Visit:                      | Mohawk      | Ruslavage    |
|           |                             |             |              |
| **2007**  | St. Regis Mohawk            |             |              |
+-----------+-----------------------------+-------------+--------------+
| **Jan. 29 | Dental Site Visits:         | Poarch      | Dr. Tim      |
| -- Feb.   |                             | Creek       | Ricks        |
| 1, 2007** | Poarch Creek,               |             |              |
|           | Alabama-Coushatta           | Alabam      | Dr. Cathy    |
|           |                             | a-Coushatta | Hollister    |
+-----------+-----------------------------+-------------+--------------+
| **Feb.    | USET -- Office of Public    | NAO         | OPH Staff    |
| 5,**      | Health                      |             |              |
|           |                             |             | USET Staff   |
| **2007**  | Combined Staff meeting      |             |              |
+-----------+-----------------------------+-------------+--------------+
| **Feb.    | USET Impact Week            | Arlington,  | All OPH      |
| 12-14,**  |                             | Virginia    | Staff        |
|           |                             |             |              |
| **2007**  |                             |             |              |
+-----------+-----------------------------+-------------+--------------+
| **Feb.    | Fundamentals of Medical     | Ft.         | Kristina     |
| 14-16,**  | Grant Writing Workshop      | Lauderdale, | Rogers       |
|           |                             | Florida     |              |
| **2007**  |                             |             |              |
+-----------+-----------------------------+-------------+--------------+
| **Feb.    | IHS Combined Councils'      | San Diego,  | Dr. Tim      |
| 26-Mar.   | Meeting                     | California  | Ricks        |
| 2,**      |                             |             |              |
|           |                             |             |              |
| **2007**  |                             |             |              |
+-----------+-----------------------------+-------------+--------------+
| **Feb. 27 | Regional HIV/AIDS           | Nashville,  | Dr. Palmeda  |
| -- 28,**  | Conference                  | Tennessee   | Taylor       |
|           |                             |             |              |
| **2007**  |                             |             |              |
+-----------+-----------------------------+-------------+--------------+
| **Feb. 27 | DATA TRANSMISSIONS ARE DUE  | ** **       |              |
| --        | AT AREA OFFICE              |             |              |
| Mar.1,**  |                             |             |              |
|           |                             |             |              |
| **2007**  |                             |             |              |
+-----------+-----------------------------+-------------+--------------+
| **Feb.    | Nashville Area Dental Call  | 86          | Dr. Tim      |
| 28,**     | 11-12 CT                    | 6-766-7230; | Ricks        |
|           |                             | Passcod     |              |
| **2007**  | (all dental programs        | e--6920488# | (Call        |
|           | invited)                    |             | Leader)      |
+-----------+-----------------------------+-------------+--------------+
| **March 5 | Dental Site Visits:         | Maine       | Dr. Tim      |
| -9,**     |                             |             | Ricks        |
|           | Passamaquoddy IT,           |             |              |
| **2007**  | Passamaquoddy PP,           |             | Dr. Cathy    |
|           |                             |             | Hollister    |
|           | Micmac, Penobscot, Maliseet |             |              |
|           | (tentative)                 |             |              |
+-----------+-----------------------------+-------------+--------------+
| **March   | Tips and Tools for Routine  | TBA         | Dr. Palmeda  |
| 12-16,**  | Health Screening and        |             | Taylor       |
|           | Documentation in Primary    |             |              |
| **2007    | Care                        |             | Mary         |
| (ten      |                             |             | Wachacha     |
| tative)** |                             |             |              |
|           |                             |             | (Leaders)    |
+-----------+-----------------------------+-------------+--------------+
| **Mar.    | DATA TRANSMISSIONS ARE DUE  | ** **       |              |
| 27-Apr.   | AT AREA OFFICE              |             |              |
| 1,**      |                             |             |              |
|           |                             |             |              |
| **2007**  |                             |             |              |
+-----------+-----------------------------+-------------+--------------+
| **March   | Nashville Area Dental Call  | 86          | Dr. Tim      |
| 28,**     | 11-12 CT                    | 6-766-7230; | Ricks        |
|           |                             | Passcod     |              |
| **2007**  | (all dental programs        | e--6920488# | (Call        |
|           | invited)                    |             | Leader)      |
+-----------+-----------------------------+-------------+--------------+