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.
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Date *
Call Number *
Chief Complaint *
Assessment *
Please document what you saw when you arrived. What the patient told you. What treatment you gave.
Check the boxes that indicate what you did on the call
Your Name: *
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