USSONAR | Application Form

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We will email you the first week in October to inform you whether you have been accepted into the training program.

First Name

Last Name

NPI Number (MINC for Canadian provider)

Email Primary (not your academic institution as your login associated with the email may be continued after completion of fellowship training; Gmail preferred as you will need to upload google folder URL's with a Google Drive)

This will be used for the training program so ensure that you regularly access this email account.

Email Secondary

If we are unable to reach you using your primary email. (Can be same as primary if don't have a secondary email.)

**Name of the institution or practice where you work

**Name of local ultrasound mentor (or program director if don't have a mentor)

**Email of local ultrasound mentor (or program director if don't have a mentor)

Name of the institution or practice where you work

Name of local ultrasound mentor (or program director if don't have a mentor)

Email of local ultrasound mentor (or program director if don't have a mentor)

Make and model of ultrasound equipment available for your use

Available transducers

Check all that apply.

≤10 MHz Linear

≤12 MHz Linear

≤18 MHz Linear

≤5 MHz Curvilinear

≤8 MHz Curvilinear

How many CME hours of training do you have in musculoskeletal ultrasound?

How many independent musculoskeletal ultrasound studies have you performed up to this point?

Please provide a 4-6 sentence paragraph regarding: What is your plan for completing the USSONAR Fundamentals Program? Have you carved out time in Clinic for US? Do you have support from your program director and others?

How do you plan to use ultrasound in your future work?

Upload one ultrasound image of your own wrist, labeled with your name

Upload an image attachment (png or jpg format and 4MB file limit)

Fellows: Upload signed program director letter of support that you downloaded from above.

Upload a PDF attachment (4MB file limit)

Nonfellows: Upload signed letter of agreement that you downloaded from above.

Upload a PDF attachment (4MB file limit)

HIPAA Agreement

Please read the following statement indicating that you are aware of HIPAA regulations and that you will only send de-identified patient ultrasound images to the program website:

"I am aware of, and will comply with the requirement to only transmit ultrasound images of patients that have had all identifying information removed. I understand that failure to remove patient identifiers prior to transmission of ultrasound images would be a violation of HIPAA rules. I am aware that failure to comply with HIPAA can result in civil and criminal penalties (42 USC § 1320d-5)."

Do you agree to the HIPAA Agreement?

Yes, I have read and accept the HIPPA Agreement.

Participation Agreement

Please read the following statements about program participation:

Participation Agreement #1: "I understand that all of the ultrasound images that I upload to USSONAR must have been obtained by me, and that uploading ultrasound images obtained by anyone other than me is sufficient ground for exclusion from the program."

Participation Agreement #2: “I agree to participate in the full educational program including the web-based virtual hands-on workshop and final examination. It is my responsibility to recruit a healthy volunteer to scan all of the joint regions covered in the USSONAR program for both of these sessions, and I will not graduate from the program without this. As part of this process I agree to mail the ultrasound equipment lent to me by insured, overnight mail back to USSONAR on the next business day following completion of use of the equipment.”

Participation Agreement #3: "I understand that I will receive a certificate of completion following the final exam, confirming the number of complete scans I uploaded over the year, but that the exam will not result in any official credentialing in musculoskeletal ultrasound."

Participation Agreement #4: "I understand that by participating in this course I am giving permission to have educational metrics used for future research publications, and granting permission to use de-identified images for future research projects (USSONAR copyright)

Participation Agreement #5: I agree to participate in USSONAR's educational metric survey via Qualtrics. In order to be considered for course acceptance, please complete the following survey: USSONAR Fundamentals in Musculoskeletal Ultrasound Training Program Applicant Survey 25/26

Do you agree to ALL 5 Participation Agreements?

Yes, I have read and accept the Participation Agreement #1

Yes, I have read and accept the Participation Agreement #2

Yes, I have read and accept the Participation Agreement #3

Yes, I have read and accept the Participation Agreement # 4

Yes, I have read and accept the Participation Agreement # 5

I consent to the program sharing my name and email address with a limited number of industry companies as part of the Fundamentals exhibitor program (Leave unchecked if you do not wish for your information to be shared)

I consent to having my information shared

Leave uncheck if you do not wish for your information to be shared

Terms of Use Agreement

(Note: the link below will open up a new browser window or tab. After you complete reading the Terms of Use you can close the window or tab.)

Click here to read the Terms of Use agreement required for program participation.

Do you agree with the USSONAR Terms of Use Agreement?

Yes, I have read and accept the USSONAR Terms of Use Agreement.

Yes, I understand that the information I provided will be stored for purposes related to my application.

Apply Now

Files to download:

Program Director Letter of Fellow Support

Non-Fellow Letter of Agreement

HIPAA Agreement

Participation Agreement

Terms of Use Agreement

Apply Now

Files to download:

Program Director Letter of Fellow Support

Non-Fellow Letter of Agreement

﻿HIPAA Agreement

Participation Agreement

Terms of Use Agreement

HIPAA Agreement