Certified Ophthalmic Executive Recertification Application

Certified Ophthalmic Executive Recertification Application

At the conclusion of each three-year credentialing cycle, individuals holding the Certified Ophthalmic ExecutiveTM designation must provide proof of 50 continuing education credits by completing, submitting and signing this form. A minimum of 25 credits must be Category A Credits. Credits must be earned within the credentialing cycle.

Personal Information
Name*

First NameLast Name
Credentials/Designations
Practice/Organization*
E-mail*
example@example.com
COE Expiration Date
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone Number

Continuing Education Credit Information
Individuals must provide proof of 50 continuing education credits. Credits must be earned within the credentialing cycle.

Continuing education credits are divided into the below three sections.

Category A: Eyecare

Ophthalmic-specific management programs/courses, as well as technical and medical courses.*

COEs must submit a minimum of 25 hours in Category A per three‐year credential period. There are no maximum limitations in this category.

All Category A activities yield a 1:1 credit ratio of hours spent to hours earned.

Category B: General Management/College Courses

There are no minimum or maximum limitations in this category.

All category B activities yield a 1:1 credit ratio of hours spent‐to‐hours earned.

Category C: Miscellaneous

Activities must be within the 6 COE content areas (general ophthalmic knowledge, financial management, operations, information technology management, human resources, risk management & regulatory compliance).

COEs may submit up to 18 hours in Category C per three‐year credential period.

Category C activity credit ratios depend on the specific activity. See the COE recertification guidelines for a full breakdown of activities and credit rations.

*Courses related to clinical patient care taught by industry device manufacturers or pharmaceutical companies are not eligible for COE credit.

List the total continuing education credits earned during the past three years in each category *

	Number of Credits
Category A: Eyecare
Category B: Management
Category C: Miscellanious
Total Number of Credits

Please upload a list of all continuing education credits earned during the past three years.

Download the COE Record of Continuing Education Credits (opens as a pdf) form or provide your own document.
Credit Record*

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Payment Information

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COE Recertification- MemberCOE recertification for member

$150.00 Quantity

COE Recertification Non-MemberCOE recertification for non-member

$200.00 Quantity

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Signature
I hereby attest the above information is true and accurate to the best of my knowledge.

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