PRE-APPROVAL OF SPECIALTY CME CREDIT
FOR SPONSORS OF CME PROGRAMS
Organization Name Click here to enter text.
Sponsor ID (if known) Click here to enter text.
AOA Accredited Category 1A CME Sponsor ☐
Address Click here to enter text.
City, State, Zip Click here to enter text.
Contact Name Click here to enter text.
Email Address Click here to enter text.
Event Name Click here to enter text.
Event Dates Click here to enter text.
Location (City, State) Click here to enter text.
Session(s) for Which Specialty CME is Sought
Session 1
Session Title
Date and Time of
Session
Presenter (Include
Credentials)
Learning
Objectives
Session 2
Session 3
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Use the second page of this form to indicate the specialties for which specialty CME pre-approval is requested.
Visit Osteopathic.org for a listing of specialty tables of specification for help if needed. For additional sessions,
use an additional form and include as one submission to the AOA.
Submit this form and agenda to certification@osteopathic.org or mail to:
Division of Certification
American Osteopathic Association
142 E. Ontario Street
Chicago, IL 60611
SPECIALTIES (mark the number of specialty credits being sought per session)
Board
Anesthesiology
Dermatology
Emergency
Medicine
Family
Physicians
DESCRIPTION
Anesthesiology
Pain Management
Critical Care
Dermatology
MOHS Micrographic Surgery
Emergency Medical Services
Emergency Medicine
Medical Toxicology
Adolescent & Young Adult Medicine
Family Medicine/OMT
Geriatric Medicine
Cardiac Electrophysiology
Internal
Medicine
Neurology
&
Psychiatry
Neuromusculoskeletal
Medicine
Nuclear
Medicine
Obstetrics
&
Gynecology
Ophthalmology &
Otolaryngology
Orthopedic
Surgery
Cardiology
Critical Care Medicine
Endocrinology
Gastroenterology
Geriatrics
Hematology
Infectious Diseases
Internal Medicine
Interventional Cardiology
Nephrology
Oncology
Pulmonary Diseases
Rheumatology
Child Neurology
Child Psychiatry
Geriatric Psychiatry
Neurology
Neurophysiology
Psychiatry
Neuromusculoskeletal Med/OMM
Spec Prof in Osteopathic Manipulative
Medicine
Nuclear Medicine
Female Pelvic Med/Reconstructive
Surgery
Gynecological Oncology
Maternal & Fetal Medicine
Obstetrics & Gynecologic Surgery
Obstetrics & Gynecology
Reproductive Endocrinology
Ophthalmology
Otolaryngology & Facial Plastic Surgery
Otolaryngic Allergy
Otolaryngology
Otorhinolaryngology
Hand Surgery
Orthopedic Surgery
1
2
3
Board
Pathology
Pediatrics
Physical
Medicine
& Rehab
Preventive
Medicine
Proctology
Radiology
DESCRIPTION
Anatomic Pathology
Anatomic Pathology & Lab Medicine
Forensic Pathology
Laboratory Medicine
Adolescent Medicine
Neonatology
Pediatric Allergy & Immunology
Pediatric Endocrinology
Pediatric Pulmonology
Pediatrics
Physical Medicine & Rehabilitation
Preventive Med-Aerospace Medicine
Preventive Med-Occupational Med
Preventive Medicine-Public Health
Preventive-Occupat’l-Environm’l Med
Proctology
Angiography & Intervention Radiology
Body Imaging
Diagnostic Radiology
Diagnostic Roentgenology
Diagnostic Ultrasound
Neuroradiology
Nuclear Radiology
Pediatric Radiology
Radiation Oncology
Radiation Therapy
Radiology
Vascular/Interventional Radiology
Cardiothoracic Surgery
Critical Care Surgery
Facial Plastic Surgery
General Vascular Surgery
Surgery
Neurological Surgery
Plastic & Reconstructive Surgery
Conjoint
Surgery (General)
Thoracic Cardiovascular Surgery
Thoracic Surgery
Urological Surgery
Addiction Medicine
Allergy and Immunology
Correctional Medicine
Dermatopathology
Hospice and Palliative Medicine
Pain Medicine
Sleep Medicine
Sports Medicine
Undersea and Hyperbaric Medicine
1
2
3