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