Continuing Medical Education Reporting Form

INSTRUCTIONS

1. Form to be used for recording CME Credit Hours of attendance at Texas Orthopaedic Association programs/courses.  This CME Reporting is for the joint providership with Texas Orthopedics, Sports and Rehabilitation Associates event held February 23, 2019.

2. Record each program/course/workshop attended and the number of credit hours. Credit hours are based on hour-for-hour attendance.

CME Accreditation and Credit Designation: Texas Orthopaedic
Association is accredited by the Texas Medical Association to provide
continuing medical education for physicians.

Texas Orthopaedic Association
401 West 15th Street #820
Austin, Texas 78701
(512) 370-1505 • (866) 864-1568 (fax)

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* 1. First Name:

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* 2. Last Name:

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* 3. Suffix (MD, DO, RN, PA or n/a etc)

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* 4. Street Address:

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* 5. City:

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* 6. State:

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* 7. Zip Code:

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* 8. Email Address:

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* 9. If you attended the entire meeting - enter 1 below.
(and skip to question #11)

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* 10. If you attended partially - enter number of hours below. (.25, .50, .75 etc)

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* 11. I certify to the best of my knowledge that the above information is correct.

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* 12. Thank You! Your CME Certificate will be emailed to you at a later date.  Please enter today's date:

Date
0 of 12 answered
 

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