Carolyn Downing
ISMA
322 Canal Walk
Indianapolis, IN 46202

	Yes, I am interested in serving on a Chapter committee. My choice(s) is/are indicated below.
	I am willing to serve on any Chapter committee.
	Health and Public Policy Committee (advocates positions to state legislators; advises the Governor on national policy positions; interact with third-party carriers and with other professional and public groups.)
	Medical Services Subcommittee (works to solve state-level problems involving Medicare, Medicaid, and other third party carriers.)
	Education Committee (responsible for annual chapter meeting; promote use of best practice guidelines; determine ways to stimulate learning and usage of electronic resources.)
	Membership Committee (increase membership in the Chapter; maintain membership needs and interests database; encourage and recognize advancement to FACP.)
	Awards Committee (propose Chapter members who should receive recognition for excellence, such as the Laureate award, Mastership; determine means to recognize non-physicians, such as legislators or business people, who have made important contributions to excellence in internal medical care.)

Are you interested in volunteering to serve as a peer reviewer for our medicare carrier?

Dr. Arnold Krubsack, Medical Director for the Indiana Medicare Part B Carrier, would like to establish a peer review network to help the Carrier with the claims review process. He would like the names of internists throughout the state willing to serve in this capacity. The Chapter Council and the Health and Public Policy Committee have discussed Dr. Krubsack's request and unanimously support it as a way to keep internists involved in the claims review process.

If interested, complete and mail this form to:

Carolyn Downing
ISMA
322 Canal Walk
Indianapolis, IN 46202

	I would like to serve as a volunteer internal medicine claims reviewer for the Carrier.
	I am potentially interested as serving as a volunteer internal medicine claims reviewer for the Carrier, but I would like to more about it before volunteering.