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KELL - SCHEDULE GRID TESTER
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How would you like your name to appear on your certificate?



How many credit hours did you complete?
Agreement
By completing this form, you attest that you have attended the number of hours you have indicated above.
Was the educational content of value to you?
Was the educational content scientifically sound?
If no, Tell us how...
Did you perceive any commercial bias or influence in the educational content?
If yes, what...
Did this program improve your Skill or Strategy in your role or contribution as a member of the healthcare team?
If no, why not?
Do you believe your participation in this activity will positively impact your healthcare team?
If yes, tell us how... Or if no, tell us why not...
Do you think what you learned will benefit you in your practice?
If yes, how...
Tell us how well or poorly we met any of the educational objectives:
What questions are you having in your practice that you would like to see addressed in an educational activity?
What barriers might you have that would interfere with implementation of new information learned from this training?
How can this training (the overall meeting) be improved to better impact knowledge, strategies/skills, performance and/or patient outcomes?
Tell us what was good or bad about any part of the educational activity, content, speakers, materials, anything at all.
Pharmacists/Pharmacy Technicians -
Please enter your NABP e-Profile ID Number in the space provided.
By providing this information, you are giving Amedco permission to electronically transmit the data to Accreditation Council for Pharmacy Education (ACPE) for credit reporting purposes. If you do not know your NABP e-Profile ID Number, visit the NABP Support Center at https://nabp.pharmacy/help/, or call 847-391-4406 for assistance. Your credits cannot be reported to CPE Monitor without this information.
Date of Birth - Month: Please select the number that represents the Month in which you were born (example: March is 03):
Date of Birth - Day: Please enter the day of the month on which you were born (example: if you were born on the 6th, please select 06).

Please enter your American Board of Internal Medicine (ABIM) Board ID Number in the space provided. 

 

By providing this information, you are giving Amedco permission to electronically transmit the data for credit reporting purposes. If you do not know your Board ID number, contact them at email@abim.org or call 1-800-441-ABIM for assistance. We cannot upload credits without a valid Board ID. 

Date of Birth - Month: Please select the number that represents the Month in which you were born (example: March is 03):

Date of Birth - Day: Please enter the day of the month on which you were born (example: if you were born on the 6th, please select 06).

Please enter your American Board of Surgery (ABS) Board ID Number in the space provided. 

 

By providing this information, you are giving Amedco permission to electronically transmit the data for credit reporting purposes. If you do not know your Board ID number, log into your ABS Portal at https://portal.absurgery.org/login, or call 215-568-4000 for assistance. We may not be able to upload credits without a valid Board ID. 

Date of Birth - Month: Please select the number that represents the Month in which you were born (example: March is 03):

Date of Birth - Day: Please enter the day of the month on which you were born (example: if you were born on the 6th, please select 06).

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Provided by amedco