CME Program Continuous Practice Form
Please fill out the following. The Education department will place a copy in your CME folder in order to track your involvement on calls. THIS DOCUMENT MUST BE COMPLETED FOR EACH CALL AND SUBMITTED NO LATER THAN 7 DAYS AFTER THE CALL TO GET CREDIT FOR CONTINUOUS PRACTICE.
Date *
Your answer
Call Number *
Your answer
Chief Complaint *
Your answer
Assessment *
Please document what you saw when you arrived. What the patient told you. What treatment you gave.
Your answer
Treatment
Check the boxes that indicate what you did on the call
Your Name: *
Your answer
Submit
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