CME On Demand Evaluation/Attestation Form

Aspirus Wausau Hospital is accredited by the Wisconsin Medical Society to provide continuing medical education programs. In order to continue offering CME, we are required to document outcomes and barriers to change to fulfill the requirements of our accreditation. Your feedback is very important; please know that no attendee names are included on the summary sent to the speaker(s) or the committee reviewing the summary.  Thank you.

Question Title

* 1. Speaker (Paul David, JD) - Presentation Skills

Question Title

* 2. Speaker (Paul David, JD) - Content

Question Title

* 3. Speaker (Paul David, JD) - Objectivity (no commercial support and/or pharmaceutical bias)

Question Title

* 4. Speaker (Paul David, JD) - Time allowed

Question Title

* 5. OBJECTIVES: Was learning objective #1 met? Define and discuss applicable state law regarding activation and deactivation of POAHCs

Question Title

* 6. OBJECTIVES: Was learning objective #2 met? Discuss best practices for documenting activation and deactivation of POAHCs

Question Title

* 7. OBJECTIVES: Was learning objective #3 met? Discuss best practices for procedurally affecting changes to a patient's POAHC status

Question Title

* 8. Did the presentation reinforce your current practice?

Question Title

* 9. Will the information alter your practice performance?

Question Title

* 10. If the information will alter your practice performance, do you believe it will produce a change in your diagnostic methods?

Question Title

* 11. If the information will alter your practice performance, do you believe it will produce a change in your treatments?

Question Title

* 12. If the information will alter your practice performance, do you believe it will produce a change in your general patient care?

Question Title

* 13. As a result of this program, what will you change when you go back to work? What will you share with your team?

Question Title

* 14. What barriers do you anticipate in incorporating what you learned in your work (check all that apply)?

Question Title

* 15. Attestation:

Question Title

* 16. This evaluation also serves as your sign-in form for viewing the presentation online. Please type your first and last name.

Question Title

* 18. Please enter your email address.

Question Title

* 19. Please enter the name of your Aspirus Hospital or Clinic, or address if you do not work at Aspirus

Thank you!  A certificate of attendance will be provided to you within 24 hours.

Statement of Accreditation: Aspirus Wausau Hospital is accredited by the Wisconsin Medical Society to provide continuing medical education for physicians.

Credit Designation Statement: Aspirus Wausau Hospital designates this live educational activity for a maximum of 1 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

T