Chiropractic CE Events

As a chiropractic assistant, the day-to-day operations of the office fall on your shoulders. At first, this role may seem daunting but not to worry - we are here to help! Running the office can only happen well if the operations are organized on the back end. Join Holly Jensen, the Queen of CA Training and Practice Efficiency, as she discusses the basic formula for achieving success at the front desk. You'll walk away with practical tips that can be immediately applied, plus a sense of ease that you can do it! This course was originally presented by Holly Jensen on April 23, 2019 and is a part of our Office Training Series sponsored by ChiroHealthUSA.

Effective October 1, 2024, significant updates to ICD-10-CM codes are coming, including 252 new codes, 36 deletions, and 13 revisions. Staying current with these changes and policy guidelines is crucial for your practice's compliance and efficiency. This program was originally presented on December 4, 2024. This course provides essential knowledge on diagnosis coding rules and regulations, helping you effectively diagnose patients, identify coding red flags, and leverage guidelines to accurately explain patient circumstances. Master the latest ICD-10 updates to ensure your practice is prepared for 2025.

This 1-hour Implicit Bias Training course is specifically designed to fulfill LARA's licensure requirements for healthcare professionals. It delivers essential, evidence-based information regarding implicit bias and its various related concepts, ensuring practitioners are well-informed on this critical topic.Participants will gain a deeper understanding of how unconscious biases can impact healthcare delivery and patient interactions. The training aims to equip attendees with practical strategies for debiasing, fostering a more equitable and effective healthcare environment for all.

This 1-hour Implicit Bias Training course is specifically designed to fulfill LARA's licensure requirements for healthcare professionals. It delivers evidence-based information, thoroughly exploring the fundamental concepts of implicit bias and its pervasive impact within healthcare settings.Participants will gain crucial insights into identifying and understanding their own unconscious biases, equipping them with practical strategies to mitigate these biases. This training is essential for fostering more equitable patient care and improving overall healthcare outcomes by promoting a more aware and inclusive professional practice.

Join KCA Executive Director Dr. Travis Oller for a practical and solution-focused webinar that breaks down the essentials of compliance in today's chiropractic office. This session will guide you through key areas where practices often struggle, including HIPAA, state licensing, legal advertising, and OSHA regulations. Dr. Oller will also introduce Statusfi, KCA's powerful compliance software available for free to KCA members, designed to help streamline tracking and maintain organization. This webinar is ideal for both seasoned chiropractic physicians and those managing a growing practice, providing tools and clarity to simplify the compliance process and protect your practice.

Dr. Carl S. Cleveland III shares an inspiring and thought-provoking message on the profession's evolution, as lived through the life of a fourth generation doctor of chiropractic and member of a pioneering chiropractic family. Experience the history of the struggle, sweat and sacrifice of the pioneers, taking the journey from a time when, "œA knock at the door brought fear of arrest..," to today, "œ"¦walking through the doors of the US Congressional Health Services on Capitol Hill." Topics of discussion include key events in chiropractic history that have shaped the profession's emerging role in today's health care systems, the evolution of core concepts fundamental to the science, philosophy, and practice of chiropractic, and strategies for advancing the next decade of chiropractic practice. This webinar is sponsored by Cleveland College of Chiropractic.

You know what they say "” give a person a fish, and you feed them for a day; teach them to fish, and you feed them for a lifetime. In this session, we're not just delivering the latest chiropractic insurance updates "” we're giving your team the tools to stay informed long after the webinar ends. We'll cover hot topics currently affecting Michigan practices, then show you how to navigate payer policies, find source documents, and confidently manage common challenges.Whether you're a doctor, CA, or biller, you'll walk away with both answers and the ability to go straight to the source the next time questions come up. Stay Tuned! This session kicks off a Lunch & Learn Series coming this fall!

An in-depth look at the importance of inclusivity (the heart of the work) as you are treating patients. We will be calling people in (rather than calling them out) for a conversation about how society continues to marginalize individuals, and how you can mitigate that in your practice.We will take a look at how bias shows up in your everyday life, and how it shows up in your practice, as well as how we miss the mark on inclusivity despite your best efforts. (Don't worry it happens to so many of us). This talk will explore how one's social location shapes whether they feel safe and respected in your space, as well as access to care, who gets overlooked and if that's even the practitioner's responsibility.

This course provides Ohio chiropractors with an up"‘to"‘date understanding of the laws and rules for chiropractic under Ohio Revised Code Chapter 4734 and the Ohio Administrative Code. The course equips licensees with the knowledge and tools needed to maintain regulatory compliance, protect their license, and deliver safe, ethical patient care.Key requirements are covered in depth, including biennial license renewal, CE hour distribution, mandated CE topics, record retention timelines, telehealth standards, patient dismissal protocols, and mandatory reporting obligations. By the end of the course, attendees will understand how to implement daily compliance practices, maintain proper documentation, uphold ethical standards, and navigate Board expectations with confidence.

According to our speaker, if we look at the 33 Principles and really dissect them and apply them into our day-to-day activities and relationships, they become an amazing rudder for our life. There are no outside in secrets to practice or life. It is 100% from the inside out. As chiropractors, the first of the 33 principles set the course for our entire existence. The one single most important ingredient to success in life and practice is incorporating the 33 Principles in and out of the office "“ with one extra measure of love. There has to be a monumental shift inside. Innate knows a fake when It sees one.

This ICD-10 webinar provides codes specifically for chiropractors get the latest coding updates and practical examples. Ensure your practice stays on top of the latest coding changes to maintain compliance and optimize reimbursement. 1 Distance Learning Documentation/Ethics Credit-DC credit only Presented By: Dave Klein PAYDC- ANJC Gold Sponsor

This event focuses on continuing education for chiropractic professionals, providing opportunities to enhance knowledge and skills essential for practice success. Key features include: - Presentations by expert speakers in the chiropractic field - A diverse selection of topics aimed at enriching professional development - Interactive sessions to engage with peers and industry leaders - Networking opportunities with fellow practitioners for collaboration and support - Comprehensive training designed to meet licensing and certification requirements

This presentation focuses on basic Personal Injury documentation, care, and management practices and principles. It emphasizes providing implementable concepts and material to improve the physician's clinical understanding and skills. The course aims to enhance provider knowledge of Personal Injury documentation and management, assist in establishing specific protocols, and help identify and correct clinical errors and practice deficiencies. Topics include initial history and examination, case management, diagnostic imaging, and proper daily treatment note documentation.

We have combined two presentations to make this on demand course. The first is some imaging studies that are reviewed by Dr. Timothy Sellers and Sponsored by EPIC Imaging/CDI Centers and the second is an introduction to new options for treating patients with new technologies known as Braintapping. Braintapping is a quick and easy way to relax, reboot and revitalize by simply optimizing your brain's peak potential"”anytime, anywhere. Backed by neuroscience and research, braintapping's guided meditation is proven to help people who experience high stress, difficulty sleeping, low energy, and other lifestyle challenges. This tool from Brain Tap Technologies can be useful in your own clinical setting as you will see from this program.

In this webinar learn to scrutinize your diagnosis code selection and documentation so that you can impress coding experts and clinicians all at the same time. At the end of this presentation, you will know how to satisfy any third party who questions the codes you have chosen. The diagnostic statement can strengthen your records and help you establish medical necessity for the care you deliver. This course was originally presented by Dr. Evan Gwilliam on July 21, 2020 and sponsored by PayDC Chiropractic Software.

This course provides essential insights into HIPAA compliance and updates for 2021, focusing on government crisis compliance and how regulatory bodies identify violations. Participants will learn strategies for preventing ransomware attacks and enhancing cybersecurity, alongside understanding the specific demands government agencies make during investigations into chiropractic practices. The curriculum further delves into an overview of compliance enforcement actions against doctors, with a particular emphasis on OIG/Medicare compliance. It outlines the required policies and components necessary for a robust HIPAA program, equipping practitioners with the knowledge to pass compliance audits and investigations successfully.

This on-demand course, "Proper Scripting and Bringing the WOW to Every Visit," focuses on empowering Chiropractic Assistants (CAs) to become true Chiropractic Advocates. Led by Lori Morgan, founder of C.A.'s For Life, the program emphasizes the importance of training CAs in effective scripts, robust systems, and essential procedures to foster practice growth and patient retention. It covers critical office operations, including first and second visit WOW procedures, managing the appointment book, implementing solid recall systems, and mastering patient retention and referral strategies. The course provides practical training through 'What to Say When' scenarios, preparing teams for various patient interactions. It also includes a team-building workshop with role-playing and mastermind sessions tailored to individual CA needs. By enhancing CAs' understanding and confidence in Chiropractic Philosophy, this program aims to unlock their full potential, enabling them to make a significant positive impact on the practice and help build the practice of your dreams.

This 1-hour course takes a look at literature-based dietary and lifestyle recommendations for managing Parkinson's disease. It aims to provide healthcare professionals with evidence-based strategies to support patients with this condition. Participants will learn literature-based dietary and exercise recommendations, with an emphasis on aerobic exercise, for Parkinson's disease symptom management. The course also reviews the literature regarding acupuncture and discusses various lifestyle modifications that can be helpful in managing Parkinson's disease symptoms.

Dr Charles takes you on a learning and practical journey through Applied Kinesiology (AK) in this extensive course. The course includes multiple sessions covering: Session 1 - Functional Neurological Assessment Parts 1-4 (11 hours total) covering muscle testing, neurological function assessment, five key factors, reflex techniques, and treatment methods. Session 2 - Scientific Muscle Testing and Postural Analysis Parts 1-3 (10 hours total) covering proper muscle testing technique, pelvic examination, leg length discrepancies, Piriformis syndrome, and intraosseous subluxations. Session 3 - Cranial Diagnosis and Treatment Parts 1-3 (8 hours total) covering cranial function, spheno-basilar mechanics, sutural faults, and cranial muscle assessment. Applied Kinesiology is the science of healing the total person through the study of movement and integral muscle function. The course teaches how to diagnose conditions through muscle testing, therapy localization, and various assessment techniques, with emphasis on nutrition and treatment options for chiropractors.

This on-demand course, "2024-03 Medicare Updates," is presented by the highly experienced Dr. Mario Fucinari. Designed for chiropractors and staff, this program offers 2 CE credits and focuses on the latest Medicare regulations and compliance requirements. Participants will gain essential knowledge to navigate the complexities of Medicare billing and documentation effectively. Dr. Fucinari, a recognized expert in chiropractic billing and compliance, draws upon his extensive background in HIPAA, clinical documentation, and Medicare to deliver practical insights. This course is crucial for practitioners seeking to optimize their practice's adherence to current Medicare guidelines, ensuring proper procedures and avoiding common pitfalls.

Many great practitioners struggle to offer exercise to their patients. Those that do offer exercise often "œstall out" after a few exercises, unable to progress and challenge the patient. Both of these approaches can create bored patients who stop coming in. This course will present a systematic method to engage every patient in engaging, advanced rehab that also leads directly into exercise.At the end of this 1-hour course, providers will be able to progress and challenge every patient with rehab strategies, as well as be able to adapt exercise protocols to even the most difficult patient cases. Access to on demand products expires on the last day of the calendar year. They must be viewed/completed within the calendar year in which they are purchased.

Stay compliant with HIPAA's required annual training and the 45-day new-hire rule. Access a 1-hour training video, outlines, and attendance forms"”all in one convenient program! This is not your ordinary informational HIPAA seminar--this is the annually required HIPAA training that your clinic must document. This program provides essential annual HIPAA training for chiropractors and clinic staff, ensuring your practice meets regulatory requirements. It includes a comprehensive 1-hour training video, detailed outlines, and necessary attendance forms, making compliance straightforward and accessible for your entire clinic.

Participate in our upcoming webinar on Official Disability Guidelines (ODG) to deepen your grasp of ODG concepts and streamline Workers' Compensation processes. Drawing from over 25 years of experience in Workers' Compensation, Dr. Carlos Boileve will share his expertise in this course. As a Certified Medical Compliance Specialist and a member of the Medical Advisory Board of the Workers' Compensation Research Institute (WCRI), Dr. Boileve brings a wealth of knowledge. He is also a Certified Insurance Consultant/Reviewer, offering insights into the latest payment requirements.During this hour, Dr. Carlos will cover the following key areas: Exploring ODG principles in detail; Delving into ODG Guidelines for cervical, shoulder, lumbar, and knee injuries; Implementing effective documentation strategies for accurate payment; Developing tactics to decrease review occurrences and ensure smoother claims handling. Don't miss out on this valuable opportunity to acquire insights and techniques for optimizing Workers' Compensation documentation and reducing review frequency.

This program is specifically designed for the student and new graduate, or that chiropractor who perhaps graduated some time ago, but is not 100% confident in their management of children. This program supports you step by step through your pediatric journey. It comprehensively covers all aspects of the pediatric experience and is specifically designed to increase your confidence and competence in your management of the pediatric patient.

Chronic pain is persistent or recurrent pain lasting longer than three months or pain occurring on at least half the days for six months or more. Estimates suggest that chronic pain affects more than 20% of the global population. The best-practice management of chronic pain requires that clinicians identify both peripheral and central pain generators, then combine passive interventions, a healthy dose of self-care, and active measures. In this 1-hour lecture, Dr. Steele will cover recent advances in pain neuroscience education, self-management, and non-pharmacologic therapies. During this hour, you will learn about these strategies matched with evidence-based treatments to manage chronic pain effectively. The chiropractic profession is uniquely positioned to deliver this care"”are you?

In this presentation, Dr. Miller will review hamstring anatomy, function and injury including both acute and chronic presentation. Conservative treatment strategies and return to play will be covered. In addition to conservative care options a brief overview of orthobiologics and surgical interventions will be discussed. This on-demand course is essential for chiropractors and healthcare professionals looking to enhance their understanding and treatment protocols for hamstring injuries, ranging from weekend warriors to elite athletes. Gain valuable insights into both conservative and advanced intervention strategies to optimize patient outcomes and facilitate effective return-to-play decisions.

Approximately 25% of sports-related injuries involve the hand and wrist and can have a significant impact on patient function. From FOOSH to repetitive use, this course will cover the top 5 most common conditions, current research, and treatment protocols recognized as best practices in sports medicine. This course includes practical, hands-on assessment and treatment concepts that can improve clinical effectiveness for practitioners dealing with athletic injuries.

This on-demand course, "20250427 OCA -Cultural Competency," is led by Dr. Mark Gabriel, DC, focusing on the critical topic of cultural competency within chiropractic care. Drawing from his extensive 15 years in healthcare and a background that blends early pharmacy roots with chiropractic expertise, Dr. Gabriel emphasizes research-based treatments and a holistic approach to patient care. Participants will gain valuable insights into effectively serving diverse patient populations, aligning with modern healthcare standards.Dr. Gabriel's unique perspective, shaped by his origins in Cairo and his practice at The Wellness Center PDX, ensures a comprehensive exploration of cultural nuances in clinical settings. The course aims to equip chiropractors and chiropractic assistants with the necessary understanding to provide inclusive and respectful care, fulfilling requirements for cultural competency credits. This program is ideal for practitioners seeking to enhance their patient communication and treatment strategies in an increasingly diverse healthcare landscape.

Dr. Woggons course "Dead Mans Curve" goes into detail on how the curves of the spine are so important and how to enact change on dysfunctional spines. This course covers cervical curve research and treatment, focusing on the need for functional spinal curves. Given free of charge in Memorium of Dr Woggon.

The Creed Neural-Kinetic Integration Technique covers a broad spectrum of applications including: correcting spinal subluxations; posture modification; regulation of organ function; extremity adjusting; 'resetting' soft tissues and balancing energy systems. This comprehensive package was produced from a 2-day workshop. This contains more than 13 hours of seminar information accompanied by a 136 page illustrated online manual.

This on-demand course, "Evidence Based Outcomes and Assessment Tools," provides chiropractors and chiropractic assistants with essential knowledge and practical skills in utilizing a range of evidence-based assessment tools. Participants will learn how to effectively implement patient-reported outcome measures and other objective assessment methods to accurately evaluate patient progress and treatment efficacy.The curriculum covers a comprehensive array of tools, including musculoskeletal-based patient-reported outcomes, various pain scales, disability indices like Oswestry and Neck Disability Index, and specific functional scales. This program is designed to enhance clinical decision-making, improve patient care documentation, and support evidence-based practice by equipping practitioners with the necessary instruments to track and demonstrate patient outcomes.

This on-demand webinar, "The Science of Cannabis and Clinical Applications of CHABA," offers a comprehensive exploration into the scientific understanding of cannabis and its practical applications within a clinical setting. Participants will gain valuable insights into the therapeutic potential and considerations of cannabis, specifically focusing on CHABA. The course is designed to equip healthcare professionals with the knowledge necessary to navigate dietary and nutrition advice, governmental regulations relevant to chiropractic and public health, and effective patient/case management, documentation, and coding related to cannabis. Understanding symptomatology in the context of cannabis use will also be covered, enhancing practitioners' ability to provide informed care.

This program, presented by Dr. Michael Wax and Tony Dick, delves into "Unlocking the Potential of the Endocannabinoid System for Chiropractic Care." Participants will gain a comprehensive understanding of the endocannabinoid system and its crucial role in overall health and wellness, specifically within the context of chiropractic practice.The course aims to equip chiropractors with the knowledge to integrate this understanding into patient care, potentially enhancing treatment outcomes and expanding their therapeutic approaches. This 1-hour on-demand program offers valuable insights into a cutting-edge area of health science relevant to modern chiropractic.

Dr Charles takes you on a learning and practical journey through Applied Kinesiology (AK) in this extensive course. The course consists of three sessions covering: Session 1 - Functional Neurological Assessment (Parts 1-4, 11 total hours); Session 2 - Scientific Muscle Testing And Postural Analysis (Parts 1-3, 10 total hours); Session 3 - Cranial Diagnosis and Treatment (Parts 1-3, 8 total hours). Topics include muscle testing to assess neurological function, therapy localization, muscle inhibitions, mechanoreceptors, spinal fixations, postural analysis, pelvic examination, piriformis syndrome, cranial diagnosis and treatment, cranial muscle assessment, and diagnostic flowcharts. Learning objectives include understanding Dr. Goodheart's system, performing accurate muscle tests, diagnosing and treating musculoskeletal conditions, conducting postural analysis, treating cranial subluxations, and developing comprehensive treatment plans.

In this session, participants will delve into the anatomy and physiology of the urinary system, gaining a comprehensive understanding of its structure and function. The course will detail the intricate process of urine formation and its physiological implications, providing essential knowledge for clinical practice. Attendees will also explore the process of micturition and learn about the clinical significance of urinalysis, equipping them with valuable diagnostic tools and enhancing their ability to address related health concerns.

A recorded 4-hour session from the Indiana State Chiropractic Association's 2023 Mini Conference (Part 2), offered on demand in audio and video formats for 4 continuing education credits. The faculty are Drs. Andrew Wohler, Sydney Harman, Tony Origer, Chris Gray and Shane Rose of Forte Sports Orthopedic Center. Topics include interventional pain management procedures, adolescent spine injuries in sports and exercise considerations for the adolescent athlete. ISCA members receive member pricing.

In this course you will learn a powerful adjustment for the whole cervical spine called "The Occipital Lift". This in depth course will show you how to perform this adjustment with line of drive, multiple camera angles, indications, tips and advice. This is a real clinic changing adjustment when performed correctly.

This course, led by Dr. Marty Kotlar, examines the Durable Medical Equipment (DME) prescribing and ordering process. Participants will learn how to create care plans that demonstrate the medical necessity for DME services, including lumbar braces and home use cervical traction. The educational session also covers important coding and documentation techniques essential for proper usage and reimbursement. Originally delivered on June 1, 2012, this course is designed for healthcare providers aiming to enhance their understanding of DME requirements and improve patient care through effective documentation. Key highlights of the course include: - In-depth coverage of the DME prescribing process. - Insights into formulating medical necessity in care plans. - Emphasis on coding and documentation practices for lumbar braces. - Practical applications for home use cervical traction.

Handling workers compensation appeals can be a daunting process. This course will walk the attendee through documentation requirements, Illinois requirements, ODG Guidelines, and more. Additionally, Dr. Brian Berkey will walk you through workers compensation expectations, utilization review, and clinical peer reviews. After the course, you should have a good understanding of the full utilization review appeal process and be equipped with appropriate appeal letters.

This course, presented by Dr. Francis Murphy, focuses on adjustive techniques, specifically highlighting the OTZ Tension Adjustment Technique. Dr. Murphy, a renowned expert, discovered a cervical spine cause for Frozen Shoulder Syndrome and has since taught his innovative technique to doctors globally. The curriculum is designed to provide chiropractors with advanced skills in spinal adjustments. Participants will gain valuable insights into the diagnosis and treatment of conditions like Frozen Shoulder Syndrome through Dr. Murphy's specialized approach. The course leverages his extensive experience as a clinician, author, and faculty member, offering practical knowledge to enhance patient care and expand the therapeutic capabilities of chiropractic professionals.

For the past 30 years, Dr. Juergens has been treating world-class athletes from around the globe. During this webinar, Dr. Juergens will review lower extremity biomechanics. He will share his experiences on how to diagnosis and manage lower extremity injuries as well as demonstrates how to incorporate a variety of active care techniques into your practice. Dr. Juergens will present Case studies of common and uncommon lower extremity conditions. This course will provide useful information that you can implement in the treatment of your patients when you return to work Monday morning.

In this on-demand online training, you’ll learn how to identify and correct vagus nerve imbalances using specific chiropractic techniques. This course offers a step-by-step breakdown of the neurological anatomy and physiology of the vagus nerve and outlines practical, hands-on protocols to address its involvement.

This workshop focuses on treating the most common pediatric lower extremity complaints encountered in chiropractic practice. It is designed to enhance chiropractors' clinical confidence when managing non-spinal conditions. Participants will learn to evaluate and treat issues related to the lower extremity, including practical approaches for in-office and home-based rehabilitation. Key features include:- Comprehensive review of normal lower extremity anatomy and biomechanics.- Identification of functional biomechanical deficits.- Practical management of various structural lower extremity pathologies, including Patellofemoral Pain Syndrome, Osgood Schlatter, Medial Tibial Stress Syndrome, and Sever’s Disease. Attendees will gain valuable insights and skills to improve treatment outcomes and increase patient engagement in their recovery processes.

This on-demand course, "The Mind Body Connection," presented by Dr. Trevor Berry, DC, DACNB, delves into the profound interplay between neurological function and overall physical well-being. Participants will explore an integrative approach to understanding how the brain and nervous system influence the entire body, offering a comprehensive perspective on health optimization and addressing complex conditions. Dr. Berry, a board-certified chiropractic neurologist, shares his extensive expertise in integrative neurology, functional medicine, and low-level laser therapy. The course is designed for practitioners seeking to enhance their knowledge of brain-body optimization, providing valuable insights into innovative non-thermal laser applications and advanced diagnostic and therapeutic strategies for neurological disorders.

Having the right forms saves time, reduces risk, and keeps your practice running smoothly. In this session, we'll walk you through how to access the Illinois Chiropractic Society's comprehensive Forms & Templates library; learn which template fits your needs (consent forms, financial policies, HIPAA logs, HR documents, and more), how to download and customize them, and how to put them into action in your office. This is part of the ICS Workshop Wednesdays, and was originally presented on February 4 2026. Each session will be a quick, practical, no-more-than-30-minute live walk-through of one of your ICS member benefits. These aren't slideshows"”they're screenshared demonstrations showing exactly how to use tools and resources that can improve your practice, save you time, or help your staff.

Join Dr. Jensen for an informative session focusing on the fundamental biomechanical principles that relate to proper joint loading and movement. This course will cover methods to assess abnormalities in movement parameters and strategies to address these issues in chiropractic practice. Participants will gain insights from Dr. Jensen’s extensive experience and expertise in structural biomechanics to enhance their clinical practices. This webinar was originally presented on June 6, 2023, and is sponsored by Foot Levelers, Inc. Key features of this course include:- In-depth exploration of biomechanical principles- Practical assessment techniques for joint movement- Application of knowledge in a chiropractic setting

This course offers insights into the role of chiropractic health promotion beyond just adjustments. Key topics include:- Overview of motivational interviewing techniques- Discussion of the OARS and RULE approaches for patient interaction- Importance of wellness screening in chiropractic practice- Introduction to the Five A’s and FRAMES methods for addressing health risk behaviors- Resources for further integrative care referrals. Participants will leave with a clear understanding of how to develop actionable plans in health promotion screenings, emphasizing the significance of patient readiness for behavior change.

This seminar focuses on the essential documentation standards for chiropractic care following auto crashes. Presented by Chris Best, this course covers best practices for creating detailed, organized records that support clinical decision-making, insurance claims, and potential legal cases. Participants will learn how proper documentation strengthens patient advocacy, improves claim approval rates, and protects the practice. The seminar emphasizes practical techniques for capturing injury mechanisms, clinical findings, and progress notes in ways that are both clinically sound and defensible.