11-8-2016 DOM Grand Rounds Survey

1. DOM Grand Rounds Electronic Sign-in

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* 1. First Name

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* 2. Last Name

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* 3. Email Address

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* 4. By checking the box I certify that I was present for Grand Rounds either in person, or at a site with live video streaming.

I was present

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* 5. Department Position

Faculty Member

Resident

Fellow

PA/NP

Student

Administrative Support

Guest (please enter academic affiliation)

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* 6. Do you wish to claim CME credit for this educational activity?

YES, I wish to claim CME credit

NO, I do not wish to claim CME credit

The Emory University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians.

The Emory University School of Medicine designates this educational activity for a maximum of 1.0 AMA PRA Category 1 credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity.