SAMPLE LETTER OF INTENT (LOI) FOR INITIAL CME ACCREDITATION APPLICATIONS
Administrator CME Program
Institute for Medical Quality
180 Howard Street, Suite 210
San Francisco, CA 94105
Name of Prospective CME Provider Organization
Address
City, State, Zip
Website Address:
Re: Intent to Apply for CME Accreditation
Dear IMQ,
This letter states my organization’s interest in becoming an accredited Continuing Medical Education
(CME) provider. The following best describes our organization:
1.
Type of organization: Please check the category that most accurately describes your organization and provide details related to the category you select.
__Hospital/Health Care Delivery System (name of the system):
__ Medical Group
__Non Profit Physician Membership Organization (specialty society)
__Other Non Profit Organization (please specify):
__Insurance Company or Manage Care Company
__Publishing/Education Company
__For profit (please specify):
__Government or Military
__Other or not classified (please specify):
2.
Is your organization: ___ for-profit or ___ non-profit? Please state the tax classification for your organization:
3 .
The ACCME defines a commercial interest as any entity producing, marketing, producing, marketing, re-selling or distributing health care goods or services consumed by, or used on, patients. A commercial interest is not eligible for accreditation. The ACCME does not consider providers of clinical service directly to patients to be commercial interests. To be considered as a candidate for accreditation you must attest to the following by checking each statement:
__We are not a commercial interest under the ACCME definition.
__We do not have a parent organization or any sister organization(s) that is a commercial interest under the ACCME definition.
4.
Briefly describe your plans for your CME program in terms of the: a.
Physician learners you are targeting for your educational activities: b.
Types and frequencies of CME activities you intend to conduct: c.
Percent of physician learners you estimate will be from within the state of California and/or neighboring states including Alaska and Hawaii? ___%
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5.
Identify your Primary CME Contact: a.
Name: b.
Phone: c.
Email address:
Signature
Name
Chief Executive Officer or Executive Director Date
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