Instructions and Record of Credit Form

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Health Technology Assessment Information Service
Evidence Boot Camp II: Diagnostic Technologies and Genetic Tests
July 14-15, 2015, Plymouth Meeting, PA
How to Obtain AMA PRA Category 1 Credits™ and/or California State Nursing Contact Hours
for this live activity
CME Accreditation Statement:
This live activity has been planned and implemented in accordance with the Essential Areas and Policies of the
Accreditation Council for Continuing Medical Education (ACCME). ECRI Institute is accredited by the ACCME to
provide continuing medical education for physicians.
AMA Credit Designation Statement:
ECRI Institute designates this live activity for a maximum of 7.0 AMA PRA Category 1 Creditstm. Physicians should
only claim credit commensurate with the extent of their participation in this activity.
California State Nursing Contact hours:
This activity has been approved for 8.5 California State Nursing contact hours by the Provider, Debora Simmons,
who is approved by the California Board of Registered Nursing, Provider Number CEP 13677
Disclosure Policy:
All presenters involved in this July 14-15, 2015, live activity entitled Evidence Bootcamp II: Diagnostic Technologies
and Genetic Tests have disclosed in writing that there are no affiliations or financial interest in any corporate
organizations involved with products to which their presentation will refer during this live activity. The faculty has
further disclosed that no presentations will include a discussion of off-label uses of FDA approved medical devices
or pharmaceutical products.
Directions for obtaining CME credit or California state nursing contact hours:
Please be sure to sign in and out each day you are requesting credit. A sign-in/out sheet is located at the front
registration desk. Please complete and sign the Record of Attendance Form on the next page, and submit to the
registration desk on your final day of attendance at the conference. If you qualify, a credit certificate will be
emailed to you, based on the information listed in that form. Completed forms must be submitted at the time
you leave the program. If you have any questions on CME accreditation, please contact Pamela Keating, JD,
Associate Director, Center for Education and Training, ECRI Institute, 5200 Butler Pike, Plymouth Meeting, PA,
19462, at pkeating@ecri.org or via phone at 610-825-6000 ext. 5439.
Evidence Bootcamp II: Diagnostic Technologies and Genetic Tests
July 14-15, 2015
Record of Attendance Form
Please return this form directly to the ECRI Registration Desk when you leave this activity in order to qualify for CME or California State
credit. A certificate will be e-mailed directly to you within 30 days if you qualify for credit. If you attend both days, please submit this form
upon your departure on Day 2 (July 15, 2015) at the registration table. Thank you.
Check which type of credit requested. All information MUST be completed in the box below to qualify for a certificate.
 AMA-PRA category 1 credit
 California State nursing contact hours
Request
for CLEARLY.
Credit. Please
PRINT
CLEARLY.
Please
PRINT
This form
must
be returned to the Registration Desk at the end of the program in order to receive a
CME Certificate via Email.
Last Name: ________________________________First Name: ___________________________ Degree: ____________
Address:
City:
_____________________
State: _______
________
Last
Name: ______________________________________
____________________________________ First
Name:
_________________________
Degree:Zip:
____________
Telephone: ____________________________ Email (req for cert): ____________________________________
Address: ______________________________________City: _____________________ State: _______ Zip: ____________
☐ I attest that I have attended ____________ hours of this live activity and should receive credit on an hour-for-hour basis,
Telephone: ____________________________________ Email Address (req for cert): ________________________________
not to exceed 7.0 hours of Category 1 credit toward the Physician’s Recognition Award of the AMA; and/or
☐ I attest that I have attended ____________ hours of this live activity and should receive credit on a 50 minute hour basis,
not to exceed 8.5 hours of California state nursing contact hours
Please record the number of hours accrued for each day. The total cannot exceed awarded credits for both days.
Signature:
___________________________________________________________
Date: _____________________
Tuesday,
July 14, 2015
Available Credit Hours
Credit Earned
1:00 pm – 2:00 pm
Evidence Frameworks to 60 minutes = 1.0 CME credits/1.2 CA nursing contact hrs _______________
Guide Analysis of Diagnostic Tests
2:00 pm – 2:45 pm
Optimizing Searches for 45 minutes = 0.75 CME credits/0.9 CA nursing contact hrs _______________
Evidence on Diagnostic Tests
3:15 pm – 3:55 pm
Risk of Bias of
40 minutes = 0.65 CME credits/0.8 CA nursing contact hrs _______________
Diagnostic Test Evidence
3:55 pm – 4:35 pm
Meta-analysis of
40 minutes = 0.65 CME credits/0.8 CA nursing contact hrs _______________
Diagnostic Tests
4:35 pm – 5:15 pm
Grading the Evidence on 40 minutes = 0.65 CME credits/0.8 CA nursing contact hrs _______________
Diagnostic Tests
Day 1
Total Earned Credit Hours
225 minutes = 3.75 CME credits/4.5 CA nursing contact hrs
_______________
Wednesday, July 15, 2015
Available Credit Hours
Credit Earned
8:30 am – 9:10 am
A Hospital Perspective:
40 minutes = 0.65 CME credits/0.8 CA nursing contact hrs _____________
To Achieve Value-based Care
9:10 am – 9:50 am
Decision Trees
40 minutes = 0.65 CME credits/0.8 CA nursing contact hrs _______________
For Diagnostic Tests
9:50 am – 10:30 pm
Special Considerations
40 minutes = 0.65 CME credits/0.8 CA nursing contact hrs _______________
for Molecular/Genetic Tests
11:00 am – 12:20 pm
Assessing Evidence on
80 minutes = 1.3 CME credits/1.6 CA nursing contact hrs _______________
Genetic Tests
Day 2
Total Earned Credit Hours
200 minutes = 3.25 CME credits/4.0 CA nursing contact hrs
Total Earned Credit Hours for Activity (Day 1 + 2) =
_______________
_______________
I attest that I have attended a total of ____________ hours of this activity and should receive credit on an hour-for-hour basis, not to
exceed 7.0 hours of Category 1 credit toward the Physician’s Recognition Award of the AMA or 8.5 California State nursing contact hours.
Signature: ___________________________________________________________ Date: _______________________
Please return this completed credit form to the ECRI Institute registration table prior to leaving the activity to be eligible for credit.
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