How would you like your name to appear on your certificate?

Profession

What activities did you attend at the event?

November 10th, 2016 9:15-10:00am

November 10th, 2016 10:00-10:45am

November 10th, 2016 11:00-11:30am

November 10th, 2016 11:30-12:00pm

November 10th, 2016 1:00-1:45pm

November 10th, 2016 2:00-2:45pm

Agreement

By completing this form, you attest that you have participated in all selected activities in thier entirety.

I agree

Please rate the speaker(s) as a group. You will have the opportunity to elaborate on an individual speaker in the following question.

Objective 1: To share national and statewide adult immunization data to illustrate the need for the Adult Immunization Standards.

By meeting the above objective my professional competence will increase because I have acquired new strategies to use in my practice.

By meeting the above objective my professional performance will improve because I should be able to implement the new strategies.

By meeting the above objective my patient outcomes should improve due to the implementation of newly-learned strategies.

If you have additional comments regarding the session or individual speaker(s) - e.g. teaching ability, expertise, organization of materials, etc. - please use the space below:

Objective 2: To educate health care providers, pharmacists and quality improvement personnel on the Adult Immunization Standards and how to implement them locally.

By meeting the above objective my professional competence will increase because I have acquired new strategies to use in my practice.

By meeting the above objective my professional performance will improve because I should be able to implement the new strategies.

By meeting the above objective my patient outcomes should improve due to the implementation of newly-learned strategies.

Objective 3: To provide health care providers and pharmacists with specific clinical tools for implementing the Adult Immunization Standards.

By meeting the above objective my professional competence will increase because I have acquired new strategies to use in my practice.

By meeting the above objective my professional performance will improve because I should be able to implement the new strategies.

By meeting the above objective my patient outcomes should improve due to the implementation of newly-learned strategies.

Please tell us about any session you found particularly good or bad

Please tell us about any objective you feel we accomplished well or poorly.

Please tell us about any presenter you found particularly good or bad

Please answer the following:

Do you believe this activity was appropriate for the scope of your professional activities?

Was the educational content scientifically sound?

Did you perceive any product/service/company/commercial bias in any educational session you attended or materials you received?

If you answered "Yes" to the above question, please detail the situation below (e.g. session title, speaker name):

What specifically did you learn during this activity that you intend to integrate into your practice?

PHARMACISTÂ need to answer this question.Â Notice to ACPE Professions: Â In order for us to report your hours to your ACPE dahsboard, you MUST provide us with your NABP ID (123456) and your DOB (MM/DD format).Â Please be sure you enter these information accurately, or hours will be be uploaded to your dahsboard.Â

What barriers might you have that would interfere with implementation of new information learned from this training?

Additional comments: