Memorial Health System Request for Preceptor Credit

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Thank you for serving as a Preceptor for MHS Residency Program. Please complete the form below to request your CME credit.

Category 1-B credit for DO preceptors is submitted to the AOA TraCME database. A maximum of 60 AOA Category 1-B credits for faculty/precepting may be applied to the 120-hour requirements per CME cycle.

MDs can self-claim AMA PRA Category 2 Credit™ for the time that they spend teaching medical students or residents.

To request the Office of CME to upload your hours to the EEDS database for your records, please complete the information below.

Are you and M.D. or D.O. *

M.D.

D.O.

Physician First Name:
*

Physician Last Name:
*

Email Address:
*

AOA number (IF APPLICABLE):

Rotation type: (i.e. Family Medicine, ED)
*

Resident’s Name:
*

Dates of Rotation: (mm/dd/yyyy)

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