3424353 Attestation - Addictions in 2014

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 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 13.50 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 (3.75 CME hrs)

Friday - afternoon sessions (3.0 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
Friday - 5/16/14 8:00 – 9:00 am Prescription Drug Abuse: It’s NOT What the Doctor Ordered – Wilson M. Compton, MD, MPE	Friday - 5/16/14 8:00 – 9:00 am Prescription Drug Abuse: It’s NOT What the Doctor Ordered – Wilson M. Compton, MD, MPE Check all that apply
9:00 – 10:00 am “Motivational Interviewing” – Joji Suzuki, MD	9:00 – 10:00 am “Motivational Interviewing” – Joji Suzuki, MD Check all that apply
10:15 – 11:15 am “Club Drugs, Bath Salts and Synthetic Cannabinoids” – Petros Levounis, MD, MA	10:15 – 11:15 am “Club Drugs, Bath Salts and Synthetic Cannabinoids” – Petros Levounis, MD, MA Check all that apply
11:15 am – 12:15 pm “Marijuana Update” – Kevin P. Hill, MD, MHS	11:15 am – 12:15 pm “Marijuana Update” – Kevin P. Hill, MD, MHS Check all that apply
1:15 – 1:45 pm A. “Psychopharmocologic Treatment of Alcohol Dependence” – Robert M. Swift, MD, PhD	1:15 – 1:45 pm A. “Psychopharmocologic Treatment of Alcohol Dependence” – Robert M. Swift, MD, PhD Check all that apply
B. “Addiction in LGBT Communities and the Crystal Methamphetamine Epidemic” – Petros Levounis, MD, MA	B. “Addiction in LGBT Communities and the Crystal Methamphetamine Epidemic” – Petros Levounis, MD, MA Check all that apply
3:00 – 4:40 pm A. “Group Therapy for Women with Substance Use Disorders” – Shelly F. Greenfield, MD, MPH	3:00 – 4:40 pm A. “Group Therapy for Women with Substance Use Disorders” – Shelly F. Greenfield, MD, MPH Check all that apply
B. “Co-Morbid Substance Abuse and Mood Disorders” – Roger D. Weiss, MD	B. “Co-Morbid Substance Abuse and Mood Disorders” – Roger D. Weiss, MD Check all that apply
Saturday, 5/17/14 - 8:00 – 9:00 am “PTSD and Substance Use Disorders” – Sudie Back, PhD	Saturday, 5/17/14 - 8:00 – 9:00 am “PTSD and Substance Use Disorders” – Sudie Back, PhD Check all that apply
9:00 – 10:00 am “Prescription Opioid Dependence” – Roger D. Weiss, MD	9:00 – 10:00 am “Prescription Opioid Dependence” – Roger D. Weiss, MD Check all that apply
10:15 – 11:15 am “Anabolic Steroid Abuse” – Harrison G. Pope, Jr., MD, MPH	10:15 – 11:15 am “Anabolic Steroid Abuse” – Harrison G. Pope, Jr., MD, MPH Check all that apply
11:15 am – 12:pm Question & Answer Panel, Morning Speakers	11:15 am – 12:pm Question & Answer Panel, Morning Speakers Check all that apply
1;15 – 1:45 pm A. “Opioid Dependence / Suboxone Treatment” – Hilary Connery, MD, PhD	1;15 – 1:45 pm A. “Opioid Dependence / Suboxone Treatment” – Hilary Connery, MD, PhD Check all that apply
B. “Working with the Patient Who Wants to Cut Down, Not Abstain” – Roger D. Weiss, MD	B. “Working with the Patient Who Wants to Cut Down, Not Abstain” – Roger D. Weiss, MD Check all that apply
3:00 – 3:30 pm A. “Couples Therapy in the Context of Addiction” – Timothy J. O’Farrell, PhD, ABPP	3:00 – 3:30 pm A. “Couples Therapy in the Context of Addiction” – Timothy J. O’Farrell, PhD, ABPP Check all that apply
B. “Co-Morbid Substance Abuse, Anxiety and Insomnia” – Kathryn McHugh, PhD	B. “Co-Morbid Substance Abuse, Anxiety and Insomnia” – Kathryn McHugh, PhD Check all that apply

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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?

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