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?

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* 5. Please indicate which sessions you attended

  Attended Did Not Attend
Friday morning Simulation - Scenario/Workshops (4 CME hrs)
Friday afternoon Simulation - Scenario/Workshops (3.5 CME hrs)
Saturday Breakfast Panel (1.5 CME hrs)
Saturday morning - sessions (3.5 CME hrs)
Saturday Lunch Panel (1.5 CME hrs)
Saturday afternoon - sessions (4 CME hrs)
Sunday breakfast panel (1.5 CME hrs)
Sunday morning - sessions (4 CME hrs)
Sunday Lunch Panel (1.5 CME hrs)
Sunday afternoon - sessions (3 CME hrs)
Monday Morning Simulation - Scenario/Workshops (4 CME hrs)
Monday Afternoon Simulation - Scenario/Workshops (3.5 CME hrs)

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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 35.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Course Only: A maximum of 14.5 AMA PRA Category 1 Credits™
Each Optional Panel: A maximum of 1.5 AMA PRA Category 1 Credits™
Each Optional Simulation Workshop Day: A maximum of 7.5 AMA PRA Category 1 Credits™

How many credits will you be claiming? *THIS QUESTION REQUIRES AN ANSWER

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