The Oklahoma State Medical Association, OU Medicine,
Oklahoma Pediatric Wellness Center and
Center for the Advancement of Wellness, OSDH
“Pediatric Obesity Management in Primary Care”
Ongoing Webinar Monthly Training for 2015
January 20, 2015
Please Print
Name:_______________________________________________________________________________________________
Address:___________________________ City: __________________State:______________________________________
Zip:_____________________________
Phone:______________________________
Fax:_____________________________________________
Please indicate status: MD_______DO________
Specialty____________________ Other________________________
To officially receive AMA PRA Category1 Credits , please complete this entire form.
Faculty/CME Planning Committee/Reviewer Disclosures: Have no relevant financial relationships to disclose.
Commercial Support: There will be no Commercial Support.
Webinar #1 – Tuesday, January 20, 2015
“Pediatric Overweight and Obesity: Overview”- Ashley Weedn, MD, OU Pediatrics - . 1) Identify pediatric overweight and
obesity. 2) Identify and assess co-morbidities of obesity through a targeted history, physical exam, and laboratory evaluation. 3)
Apply the recommended management of child obesity in clinical practice.
Please rate each question accordingly:
Excellent 5
1)Measurement of topic knowledge prior to presentation:
5
2)The program will impact me or my practice:
5
3)The objectives and disclosure were met:
5
4)The program was free of commercial bias:
5
5)Speaker was knowledgeable and
responded to the questions with detailed information:
5
6)Measurement of my knowledge of this topic
following the presentation:
5
7)Due to this presentation, improvements I plan to make:
8)Barriers that prevent change in practice:
Good 4
4
4
4
4
Avg 3
3
3
3
3
Fair 2
2
2
2
2
Poor 1
1
1
1
1
4
3
2
1
4
3
2
1
Accreditation Statement
This activity has been planned and implemented in accordance with the Accreditation requirements and Policies of the
Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Oklahoma State
Medical Association and the Oklahoma Pediatric Wellness Center. The Oklahoma State Medical Association (OSMA) is
accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education
for physicians.
The OSMA designates this live activity for a maximum of 1 AMA PRA Category 1 Credits. Physicians should claim only the
credit commensurate with the extent of their participation in the activity. __________
The OSMA CME Manager has reviewed all speaker information and has resolved all conflicts of interest if applicable.
Please email completed form to Melissa Johnson at Johnson@okmed.org or fax to
405-601-9575. Please keep a copy for your records.
Participant signature:_________________________________
Date:___________________________