311288 Attestation Form: Periperative Transesophageal Echocardiography and Echo Boards Review

1. Attendance Verification Form

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100% of survey complete.

The AMA requires that the number of credits listed on CME certificates be based on the actual credit claimed by each physician. Please complete the questions below in order to receive your CME certificate. Your certificate will be emailed to you 2-3 weeks after the survey is completed.

* Questions with an asterisk are required before evaluation can be submitted.

Thank you.

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* 1. YOUR NAME FOR CERTIFICATE: Please type your name how you would like it to appear on your certificate.
*THIS QUESTION REQUIRES AN ANSWER

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* 2. Your Degree
*THIS QUESTION REQUIRES AN ANSWER

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* 3. Your Email address for Certificate:
*THIS QUESTION REQUIRES AN ANSWER

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* 4. Did you attend the entire course?

Yes (If yes, scroll down to bottom of the page and submit your hours)

No (If no, please indicate which sessions you attended)

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* 5. Please indicate which sessions you attended

	Attended	Did Not Attend
Saturday morning session (5.0 CME hrs)	Saturday morning session (5.0 CME hrs) Attended	Saturday morning session (5.0 CME hrs) Did Not Attend
Saturday afternoon session (2.0 CME hrs)	Saturday afternoon session (2.0 CME hrs) Attended	Saturday afternoon session (2.0 CME hrs) Did Not Attend
Saturday Workshop - 1 (2.0 CME hrs)	Saturday Workshop - 1 (2.0 CME hrs) Attended	Saturday Workshop - 1 (2.0 CME hrs) Did Not Attend
Saturday Workshop - 2 (1.75 CME hrs)	Saturday Workshop - 2 (1.75 CME hrs) Attended	Saturday Workshop - 2 (1.75 CME hrs) Did Not Attend
Sunday morning session (4.5 CME hrs)	Sunday morning session (4.5 CME hrs) Attended	Sunday morning session (4.5 CME hrs) Did Not Attend
Sunday afternoon session (3.75 CME hrs)	Sunday afternoon session (3.75 CME hrs) Attended	Sunday afternoon session (3.75 CME hrs) Did Not Attend
Sunday Echo Boards (3.0 CME hrs)	Sunday Echo Boards (3.0 CME hrs) Attended	Sunday Echo Boards (3.0 CME hrs) Did Not Attend
Monday morning session (5 CME hrs)	Monday morning session (5 CME hrs) Attended	Monday morning session (5 CME hrs) Did Not Attend
Monday Afternoon session (2 CME hrs)	Monday Afternoon session (2 CME hrs) Attended	Monday Afternoon session (2 CME hrs) Did Not Attend
Monday Echo Boards (3.0 CME hrs)	Monday Echo Boards (3.0 CME hrs) Attended	Monday Echo Boards (3.0 CME hrs) Did Not Attend
Tuesday morning session (2.5 CME hrs)	Tuesday morning session (2.5 CME hrs) Attended	Tuesday morning session (2.5 CME hrs) Did Not Attend
Tuesday Echo Boards morning (3.0 CME hrs)	Tuesday Echo Boards morning (3.0 CME hrs) Attended	Tuesday Echo Boards morning (3.0 CME hrs) Did Not Attend
Tuesday Echo Boards afternoon (3.0 CME hrs)	Tuesday Echo Boards afternoon (3.0 CME hrs) Attended	Tuesday Echo Boards afternoon (3.0 CME hrs) Did Not Attend

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* 6.
ACCREDITATION

The Harvard Medical School is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Harvard Medical School designates this live activity for a maximum of 40.5 AMA PRA Category 1 Credits™.
Course Only: A maximum of 24.75 AMA PRA Category 1 Credits™
Optional Evening Physics Workshop and Hands-On Regional and Vascular Workshop (Saturday, September 24): A maximum of 3.75 AMA PRA Category 1 Credits™
Echo Boards Review: A maximum of 12.00 AMA PRA Category 1 Credits™
Physicians should claim only the credit commensurate with the extent of their participation in the activity.
How many credits will you be claiming?
*THIS QUESTION REQUIRES AN ANSWER

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* 1. YOUR NAME FOR CERTIFICATE: Please type your name how you would like it to appear on your certificate.*THIS QUESTION REQUIRES AN ANSWER

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* 2. Your Degree*THIS QUESTION REQUIRES AN ANSWER

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* 3. Your Email address for Certificate:*THIS QUESTION REQUIRES AN ANSWER

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* 4. Did you attend the entire course?

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* 5. Please indicate which sessions you attended

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ACCREDITATION

* 1. YOUR NAME FOR CERTIFICATE: Please type your name how you would like it to appear on your certificate.
*THIS QUESTION REQUIRES AN ANSWER

* 2. Your Degree
*THIS QUESTION REQUIRES AN ANSWER

* 3. Your Email address for Certificate:
*THIS QUESTION REQUIRES AN ANSWER