CME Sign In Sheet Template

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Medical Staff Services, Continuing Medical Education • 2139 Auburn Avenue • Cincinnati, OH 45219
PHONE (513) 585-2997 • FAX (513) 585-3293
CME ACTIVITY TITLE:
PRESENTER:
DATE:
Insert Presentation Title Here
Insert Presenter Name and Credentials Here
Insert Date Here
The Christ Hospital designates this live activity for 1 AMA PRA Category 1 Credit™.
Physicians should claim only the credit commensurate with the extent of their participation in the activity.
NAME (PLEASE PRINT)
CREDENTIAL (MD, PA, ETC.)
SIGNATURE
The Christ Hospital is accredited by the Ohio State Medical Association to provide continuing medical education for physicians.
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