Attestation of MI AIM Activity for 2019 Maintenance of Certification Requirements

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

ABOG Part MOC IV

First Name *

Last Name *

Email Address *

I have reviewed my email address above and it is correct. *

YES

ACOG ID (if known)

Meaningful Participation Attestation

I attest that I met the meaningful participation requirements. *

Yes

Required

I participated in this QI effort MI AIM Collaborative as follows (check all that apply): *

MI AIM Steering Committee

MI AIM Operations Committee

Maternal mortality committee

Implementation of the project’s interventions (the changes designed to improve care) at your site

Reviewed own site's data in keeping with the project’s measurement plan

Demonstrated active collaboration in the implementation of the activity at your site (e.g., team meetings, data analysis, implementation training, etc.)

Physician champion at site

Viewed or presented MI AIM coaching webinars (live or recorded - must attend 3 sessions if no other activities above)

Other:

Required

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of McLaren Health Care/ MSUCOM.

Does this form look suspicious? Report

Forms