1. Attestation Form

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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 with the next 2-3 weeks.

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

Thank you and if you have any questions, please let us know.

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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. Do you need APA credits for Psychologists? (Must have attended entire course)

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* 5. Do you need NBCC credit for counselors?

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* 6. If yes, please complete the NBCC tracking form below. Check all talks you attended, a check indicates your electronic signature:

Please skip if you do not need.
MD participants please scroll down to question 44

  Check all that apply
Scott L. Rauch, M.D., Depression, Anxiety and Stress: An Overview (20 mins)
Linda L. Carpenter, M.D., Stress: The Trajectory to Physical and Mental Health Disorders (60 mins, 9/7/12)
Dost Ongur, M.D., Ph.D., Depression: Unipolar, Bipolar, and Psychotic (55 mins, 9/7/12)
Alexander Vuckovic, M.D., Psychopharmacologic Treatment of Depression and Anxiety (60 mins, 9/7/12)
Morning Speakers, Question and Answer Panel (30 mins, 9/7/12)
Brent P. Forester, M.D., Geriatric Depression (45 mins, 9/7/12)
Marlene P. Freeman, M.D., Perinatal Mood Disorders (45 mins, 9/7/12)
Scott A. Freeman, M.D., Suicide Assessment and Prevention (45 mins, 9/7/12)
R. Kathryn McHugh, Ph.D., Co-morbid Substance Abuse (45 min, 9/7/12)
Afternoon Speakers, Question and Answer Panel (30 mins, 9/7/12)
Murray B. Stein, M.D., M.P.H., Anxiety Disorders: Diagnostic Distinctions and Treatment Response (60 mins, 9/8/12)
James A. Chu, M.D., Posttraumatic Stress Disorder (45 mins, 9/8/12)
Jeff Szymanski, Ph.D., Future Directions in Cognitive Behavioral Therapies: CBT, DBT, ACT (45 mins, 9/8/12)
H. Blair Simpson, M.D., Ph.D, Obsessive Compulsive Disorder (45 mins, 9/8/12)
Morning Speakers, Question and Answer Panel (30 mins, 9/8/12)
Katharine A. Phillips, M.D., New Developments in DSM-V (55 mins, 9/8/12)
Elizabeth P. Frates. M.D., Exercise for Depression, Anxiety and Stress (55 mins, 9/8/12)
Diego A. Pazzagalli, Ph.D., The Search for Biomarkers: The Path to Personalized Treatment (50 mins, 9/8/12)
Stephen J. Seiner, M.D., Neurotherapeutics and Treatment Resistant Depression (45 mins, 9/8/12)

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* 7. Do you need RN credits for Nurses? (Must have attended the entire course).

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* 8. Do you need SW credits for Social Workers? (Must have attended entire course).

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* 9. If yes, please enter Social Work license number:

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* 10. Did you attend the entire course?
(For Physicians)

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* 11. Please indicate which sessions you attended

  Attended Did Not Attend
Friday - morning sessions (3.75 CME hrs)
Friday - afternoon sessions (3.50 CME hrs)
Saturday - morning sessions (3.75 CME hrs)
Saturday - afternoon sessions (3.50 CME hrs)

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* 12.

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 14.50 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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