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Claudius(Incomplete)
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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.
CHES MEMBERS ONLY -- Please enter your CHES ID#
Only Florida licensees need to answer this question. Notice to Florida Licensees: In order for us to report your hours to CE Broker, you MUST provide us with your Florida alpha-numberic license number (e.g., CDCA.XXXXXX, LICDCII.XXXXXX, LCDCII.XXXXXX, LICDC.XXXXXX). Please be sure to enter this number accurately, or CE Broker will not record your hours. 
Only Ohio licensees need to answer this question. Notice to Ohio Licensees: In order for us to report your hours to CE Broker, you MUST provide us with your Ohio alpha-numeric license number (e.g., CDCA.XXXXXX, LICDCII.XXXXXX, LCDCII.XXXXXX, LICDC.XXXXXX). Please be sure to enter this number accurately, or CE Broker will not record your hours. 
(CPE Monitor) NABP e-Profile ID (ePID) - Example 123456:
(CPE Monitor) Date of Birth (MM/DD) - Example September 24 would be 0924:
CHES MEMBERS ONLY -- Please enter your CHES ID#
Only Florida licensees need to answer this question. Notice to Florida Licensees: In order for us to report your hours to CE Broker, you MUST provide us with your Florida alpha-numberic license number (e.g., CDCA.XXXXXX, LICDCII.XXXXXX, LCDCII.XXXXXX, LICDC.XXXXXX). Please be sure to enter this number accurately, or CE Broker will not record your hours. 
Only Ohio licensees need to answer this question. Notice to Ohio Licensees: In order for us to report your hours to CE Broker, you MUST provide us with your Ohio alpha-numeric license number (e.g., CDCA.XXXXXX, LICDCII.XXXXXX, LCDCII.XXXXXX, LICDC.XXXXXX). Please be sure to enter this number accurately, or CE Broker will not record your hours. 
Please rate the following:
The program was relevant to my work.
Content matched stated objectives.
Usefulness of handouts/AV/technology.
Quality of facilities and facility accommodations.
How well did the educational sessions give a balanced view of therapeutic options, including the use of generic names?
If you rated any of the above questions with 'fair,' 'poor,' 'disagree,' or 'strongly disagree' please explain in detail (e.g. session title, speaker name, situtation):
Please tell us about any sessions you found particularly good or bad.
Please tell us about any sessions you found particularly good or bad.
Please tell us about any objectives you feel we accomplished well or poorly. 
Please tell us about any objectives you feel we accomplished well or poorly. 
Please tell us about any presenters you found particularly good or bad.
Please tell us about any presenters 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?
If faculty spoke about off-label or investigational uses of a product, was that information disclosed to you?
Was the mode of education effective to learning?
If you answered "No" to any of the above questions, please explain.
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):
Were you solicited by sales personnel in an educational room (other areas do not matter) while you attended this educational activity?
If you answered "Yes" to the above question, please explain in detail (e.g. who, when, where):
How much did you learn as a result of this education program?
What specifically did you learn during this activity that you intend to integrate into your practice?
What specifically did you learn during this activity that you intend to integrate into your practice?

What questions have arisen in your practice for which you need answers/strategies that you can implement?

What questions have arisen in your practice for which you need answers/strategies that you can implement?

What patient/client problems or patient/client challenges do you feel you are not able to address appropriately or to your satisfaction?
What patient/client problems or patient/client challenges do you feel you are not able to address appropriately or to your satisfaction?
What problems are your patients/clients communicating to you that need attention or follow up?
What problems are your patients/clients communicating to you that need attention or follow up?

Are you interested in basic, intermediate or advanced level trainings?

Are you interested in basic, intermediate or advanced level trainings?

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

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 competence, performance and/or patient/client outcomes?

How can this training (the overall meeting) be improved to better impact competence, performance and/or patient/client outcomes?

Additional comments:

Additional comments:

How did you attend this course?
How did you attend this course?
Mr question
Provided by amedco