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* 1. Name

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* 2. Email Address 

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* 3. Select your organization type

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* 4. Select the option which best describes your role

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* 5. My organization’s CME activities that involve a patient care component include CLC/IB

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* 6. What are some ways your organization is addressing the CLC/IB requirements? (check all that apply)

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* 7. Have you seen an impact on patient care and/or outcomes at your organization as a result of addressing CLC/IB in physician education?

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* 8. What challenges and/or barriers to implementing the standards have you encountered? (check all that apply

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* 9. What types of resources would help ensure your success in implementing the standards? (check all that apply)

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* 10. We love to share examples of how the standards have been implemented! Please submit examples below.

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* 11. Please check here if CMA may share your example with other CME providers

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