• ASCRS Internet Point-of-Care CME Credit Form

  • Date of Search*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Primary Question Category (check one)*
  • Select Resource(s) Used*

  • Answer / Information Found and Application of Findings

  • Describe the application of your findings to your practice:
    (if not applicable, please enter n/a)

  • Describe the application of your findings to your diagnosis:
    (if not applicable, please enter n/a)

  • If the course of management and/or diagnosis was changed, how was it changed? (check all that apply)*
  • Define the difficulties in finding relevant information (check all that apply)*
  • Please select the primary impact this research had on your practice (select one)

  • CME Activity Evaluation and Credit Claim

  • Rate the overall effectiveness of this activity (select one)*
  • Did this activity meet your personal educational objectives?*
  • My search resulted in:*
  • Do you expect to change your practice as a result of this activity?*
  • When do you expect to make this change?

  • Claim Credit

    Check the box below to indicate you would like to claim 0.5 AMA PRA Category 1™ credits for this activity.

  • Maximum of 0.5 credit per completed search; up to 20 credits per calendar year may be claimed via Internet point-of-care learning, per AMA policy.

     

  • Learner Attestation

    I attest that the information above accurately reflects a clinical question that arose from my own professional practice, that I conducted the search described, and that the resource(s) used meet the criteria for peer-reviewed, evidence-based, commercially unbiased content. I am claiming credit commensurate with the time and effort spent on this activity.

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: