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322116 - Attestation Form: Program for Leading Innovations in Health Care and Education- June

2. Attendance Verification

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 attestation form 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(Required.)
2.Your Degree
*THIS QUESTION REQUIRES AN ANSWER(Required.)
3.Your Email address for Certificate:
*THIS QUESTION REQUIRES AN ANSWER(Required.)
4.Did you attend the entire course?(Required.)
5.Please indicate which sessions you attended
Attended
Did Not Attend
Sunday - afternoon sessions (2.75 CME hrs)
Monday - morning sessions (4.25 CME hrs)
Monday - afternoon sessions (2.75 CME hrs)
Tuesday - morning sessions (4.50 CME hrs)
Tuesday - afternoon sessions (2.25 CME hrs)
Wednesday - morning sessions (4.25 CME hrs)
Wednesday - afternoon sessions (2.50 CME hrs)
Thursday - morning sessions (4.0 CME hrs)
Thursday - afternoon sessions (4.0 CME hrs)
Friday - morning sessions (3.50 CME hrs)
Friday - afternoon sessions (1.0 CME hrs)
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 35.75 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

(Required.)