Improving Outcomes for People with Disabilities: Occupational Therapy, Physical Therapy, and Athletic Trainers Board (OTPTAT) CEU Credit Intake Form

OTPTAT requires reporting of this information. Please fill out this form completely if you intend to apply for OTPTAT CEU credit.

Question Title

* 1. Last Name

Question Title

* 2. First Name

Question Title

* 3. Address

Question Title

* 4. Address 2

Question Title

* 5. Address 3

Question Title

* 6. City

Question Title

* 7. State

Question Title

* 8. Zip Code

Question Title

* 9. Country

Question Title

* 10. Email

Question Title

* 11. ID Number

Enter this information if you have a unique ID number, otherwise leave blank

Question Title

* 12. Please select the sessions that you attended (check all that apply):

February 8, 2022 - Core Competencies on Disability: Guiding Principles & Values

March 8, 2022 - Core Competency #1: Conceptual and Contextual Frameworks on Disability

April 12, 2022 - Core Competency #2: Professionalism & Patient-Centered Care

May 10, 2022 - Core Competency #3: Legal & Ethical Responsibilities and Obligations in Caring for Patients with Disabilities

June 14, 2022 - Core Competency #4: Teams & Systems-based Practice

July 12, 2022 - Deeper Dive: Teams & Systems-based Practice Billing, Coding, Referring, and Coordinating Care

August 9, 2022 - Core Competency #5: Clinical Assessment

September 13, 2022 - Core Competency #6: Clinical Care Over the Lifespan and During Transitions

October 11, 2022 - Deeper Dive: Clinical Care Over the Lifespan and During Transitions Intervening Early

November 8, 2022 - Deeper Dive: Clinical Care Over the Lifespan and During Transitions

Improving Outcomes for People with Disabilities: Occupational Therapy, Physical Therapy, and Athletic Trainers Board (OTPTAT) CEU Credit Intake Form

Question Title

* 1. Last Name

Question Title

* 2. First Name

Question Title

* 3. Address

Question Title

* 4. Address 2

Question Title

* 5. Address 3

Question Title

* 6. City

Question Title

* 7. State

Question Title

* 8. Zip Code﻿

Question Title

* 9. Country

Question Title

* 10. Email

Question Title

* 11. ID NumberEnter this information if you have a unique ID number, otherwise leave blank

Question Title

* 12. Please select the sessions that you attended (check all that apply):

Question Title

* 13. OTPTAT CEUsNumber of CEUs being applied for

* 8. Zip Code

* 11. ID Number

Enter this information if you have a unique ID number, otherwise leave blank

* 13. OTPTAT CEUs
Number of CEUs being applied for