Kirksville College of Osteopathic Medicine Request for Preceptor CME Credit

***𝐓𝐡𝐢𝐬 𝐟𝐨𝐫𝐦 𝐢𝐬 ğ¬ğ©ğžğœğ¢ğŸğ¢ğœğšğ¥ğ¥ğ² 𝐟𝐨𝐫 ğŠğ‚ğŽğŒ 𝐭𝐡𝐢𝐫𝐝 𝐚𝐧𝐝 𝐟𝐨𝐮𝐫𝐭𝐡 ğ²ğžğšğ« 𝐜𝐥𝐢𝐧𝐢𝐜𝐚𝐥 𝐫𝐨𝐭𝐚𝐭𝐢𝐨𝐧𝐬.***

Thank you for serving as a clinical preceptor for third and/or fourth year KCOM medical students.  Please complete the form below to request your CME credit.

The Clinical Performance Evaluation for the rotation must be submitted by the preceptor before CME credit will be issued.

ğƒğŽ 𝐏𝐡𝐲𝐬𝐢𝐜𝐢𝐚𝐧𝐬:
Credit for osteopathic physicians is submitted to the AOA on a quarterly basis (April, July, October, January).
Credit requests must be submitted within one year following the completion of the rotation in order to be processed by the AOA.

𝐌𝐃 𝐏𝐡𝐲𝐬𝐢𝐜𝐢𝐚𝐧𝐬:
Credit is processed on a quarterly basis (April, July, October, January).
CME certificates will be emailed directly to the email address provided within this form.

Questions: Clinical Affairs 660.626.2513

To request credit for:
ğ’ğŽğŒğ€ (AZ) 𝐬𝐭𝐮𝐝𝐞𝐧𝐭𝐬: click here 
𝐄𝐚𝐫𝐥𝐲 𝐂𝐥𝐢𝐧𝐢𝐜𝐚𝐥 ğ„ğ±ğ©ğžğ«ğ¢ğžğ§ğœğžğ¬ (second year students): Call the Missouri AHEC Program 660.626.2887

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