3324353 Attestation - Addictions in 2013

1. Attendance Verification - Final Page

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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. You will need to fill out the below questions in order to receive your CME certificate. Your certificate will be emailed to you 2-3 weeks after the survey is completed.

*All Non-MD professionals must fill complete this section in order to receive certificate of attendance.

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

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

Yes

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* 6. Do you need NBCC credit for counselors?

Yes

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* 7. 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 58

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

Yes

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

Yes

If Yes, please enter Social Work license number

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* 10. Do you need continuing education credit for Certified Addiction Specialists (CAS) in accordance with the American Academy of Health Care Providers in the Addictive Disorders?

Yes

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* 11. Do you need continuing education credit for the Massachusetts Board of Substance Abuse Counselor Certification? (Must have attended entire conference).

Yes

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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 14.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

If you did not attend every session please use the session listing below to help calculate your total credits/hours to be awarded.

Friday - morning sessions (4.0 CME hrs)

Friday - afternoon sessions (3.50 CME hrs)

Saturday - morning sessions (3.75 CME hrs)

Saturday - afternoon sessions (3.00 CME hrs)
How many credits will you be claiming?
*THIS QUESTION REQUIRES AN ANSWER

	Check all that apply
5/10/13- Welcome and Introduction: Roger D. Weiss, M.D.; Shelly F. Greenfield, M.D., M.P.H.; Christopher M. Palmer, M.D. (15 min.)	5/10/13- Welcome and Introduction: Roger D. Weiss, M.D.; Shelly F. Greenfield, M.D., M.P.H.; Christopher M. Palmer, M.D. (15 min.) Check all that apply
5/10/13- Keynote Address: Healthcare Reform: How will it affect care for Substance Use Disorders? A. Thomas McLellan, Ph.D. (60 min.)	5/10/13- Keynote Address: Healthcare Reform: How will it affect care for Substance Use Disorders? A. Thomas McLellan, Ph.D. (60 min.) Check all that apply
5/10/13- Psychopharmacologic Treatment of Alcohol Dependence: Robert Swift, M.D., Ph.D. (60 min.)	5/10/13- Psychopharmacologic Treatment of Alcohol Dependence: Robert Swift, M.D., Ph.D. (60 min.) Check all that apply
5/10/13- Psychopharmacologic Treatment of Opioid Dependence: Hilary Connery, M.D., Ph.D. (60 min.)	5/10/13- Psychopharmacologic Treatment of Opioid Dependence: Hilary Connery, M.D., Ph.D. (60 min.) Check all that apply
5/10/13- Question and Answer Panel: Morning Speakers (45 min.)	5/10/13- Question and Answer Panel: Morning Speakers (45 min.) Check all that apply
5/10/13- Mood Disorders and Substance Abuse: Roger D. Weiss, M.D. (45 min.)	5/10/13- Mood Disorders and Substance Abuse: Roger D. Weiss, M.D. (45 min.) Check all that apply
5/10/13- Gender Differences in Addiction and Its Treatment: Shelly F. Greenfield, M.D., M.P.H. (45 min.)	5/10/13- Gender Differences in Addiction and Its Treatment: Shelly F. Greenfield, M.D., M.P.H. (45 min.) Check all that apply
5/10/13- Smoking Cessation in the Psychiatrically Ill: Douglas M. Ziedonis, M.D., M.P.H. (45 min.)	5/10/13- Smoking Cessation in the Psychiatrically Ill: Douglas M. Ziedonis, M.D., M.P.H. (45 min.) Check all that apply
5/10/13- Chronic Pain and Addiction: Daniel P. Alford, M.D., M.P.H. (45 min.)	5/10/13- Chronic Pain and Addiction: Daniel P. Alford, M.D., M.P.H. (45 min.) Check all that apply
5/10/13- Question and Answer Panel: fternoon Speakers (30 min.)	5/10/13- Question and Answer Panel: fternoon Speakers (30 min.) Check all that apply
5/11/13- Gambling Addiction: Marc N. Potenza, M.D., Ph.D. (50 min.)	5/11/13- Gambling Addiction: Marc N. Potenza, M.D., Ph.D. (50 min.) Check all that apply
5/11/13- Stimulant Dependence: Petros Levounis, M.D., M.A. (50 min.)	5/11/13- Stimulant Dependence: Petros Levounis, M.D., M.A. (50 min.) Check all that apply
5/11/13- Marijuana Update: Kevin Hill, M.D., M.H.S. (60 min.)	5/11/13- Marijuana Update: Kevin Hill, M.D., M.H.S. (60 min.) Check all that apply
5/11/13- Complementary and Alternative Treatments: Scott Lukas, Ph.D. (45 min.)	5/11/13- Complementary and Alternative Treatments: Scott Lukas, Ph.D. (45 min.) Check all that apply
5/11/13- Question and Answer Panel: Morning Speakers (30 min.)	5/11/13- Question and Answer Panel: Morning Speakers (30 min.) Check all that apply
5/11/13- Track Session One: Opioid Dependence/ Suboxone Treatment: Hilary Connery, M.D., Ph.D.; Motivational Interviewing: Joji Suzuki, M.D.; Dual Diagnosis: Roger D. Weiss, M.D.; Cognitive Behavioral Therapy: R. Kathryn McHugh, Ph.D. (90 min.)	5/11/13- Track Session One: Opioid Dependence/ Suboxone Treatment: Hilary Connery, M.D., Ph.D.; Motivational Interviewing: Joji Suzuki, M.D.; Dual Diagnosis: Roger D. Weiss, M.D.; Cognitive Behavioral Therapy: R. Kathryn McHugh, Ph.D. (90 min.) Check all that apply
5/11/13- Track Session Two: Opioid Dependence/ Suboxone Treatment: Hilary Connery, M.D., Ph.D.; Motivational Interviewing: Joji Suzuki, M.D.; Dual Diagnosis: Roger D. Weiss, M.D.; Cognitive Behavioral Therapy: R. Kathryn McHugh, Ph.D. (90 min.)	5/11/13- Track Session Two: Opioid Dependence/ Suboxone Treatment: Hilary Connery, M.D., Ph.D.; Motivational Interviewing: Joji Suzuki, M.D.; Dual Diagnosis: Roger D. Weiss, M.D.; Cognitive Behavioral Therapy: R. Kathryn McHugh, Ph.D. (90 min.) Check all that apply

Question Title

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

Question Title

* 2. Your Degree*THIS QUESTION REQUIRES AN ANSWER

Question Title

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

Question Title

* 4. Did you attend the entire course?

Question Title

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

Question Title

* 6. Do you need NBCC credit for counselors?

Question Title

* 7. 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 58

Question Title

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

Question Title

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

Question Title

* 10. Do you need continuing education credit for Certified Addiction Specialists (CAS) in accordance with the American Academy of Health Care Providers in the Addictive Disorders?

Question Title

* 11. Do you need continuing education credit for the Massachusetts Board of Substance Abuse Counselor Certification? (Must have attended entire conference).

Question Title

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

* 7. 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 58