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How to plan and apply for a CME activity (includes a checklist at the end)
Deadlines (in blue are hyperlinks to forms)
30 days prior to your first class in 2010
1-- Submit Joint Sponsorship Agreement
---The person who signs this form will also sign the certificates
---If you would like another person to also sign the certificates they should sign as the Joint Sponsor Representative
2-- AF 2661 -- CME Application
3-- Preplanning documentation – minutes from planning
committee, can be email traffic or memo for record
4-- Sample Agenda
5-- AF 2663 -- Objectives must be written as “measurable. Meaning they must start with words like” “Define, describe, list, etc”.
For a list of “measurable” objectives--click here
Call if you have questions DSN 665-0651
Sample AF2663
6-- Faculty disclosure and CVs – Must submit these from every:
--- Speaker/faculty, to include those on the planning committee.
--- Anyone who has control of the content of the course.
---If have someone with a conflict of interest, please have them read/sign the “conflict resolution” form. If they do not wish to sign this form, the conflict will need to be resolved by other means PRIOR to their lecture. Please contact me so we can resolve this conflict. DSN 665-0651
7-- Publicity – must have the AMA accreditation statement (see sample)
8-- Certificate – must have the AMA accreditation statement (see sample)
9-- Critique or pre/post test evaluation
– must have the same objectives as the AF 2663 if applying for nursing credit through DPAMN (POC # for them is DSN 665-0667)
Remember:
-- Approvals are for 1 calendar year basis.
2010 approvals will expire 31 Dec 10
-- Approvals are in a 2 step process – Initial approval and Final approval
--- Initial approval are the above documents and the Final approval is granted
after we receive the below documents NLT 30 days AFTER EACH class you
hold. Only then can you send out the certificates to the attendees
2010 FINAL APPROVAL FORMS
NLT 30 Days after EACH class that you hold
--Report of Health Education—Also known as the After Action
Report
--Budget worksheet—
--Budget worksheet instructions
--Class Roster—or registration list
---On the AF 2660, the SSN is not required and not encouraged as a means
for tracking students
--Class critiques (no hyperlink here)—copies of the ones the students
filled out. If a large number of attendees, please send only 5
or 10 of them.
After these are received, then I’ll send you a Final Approval letter and you can send out your certificates.
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