American Board of Pediatrics (ABP) Part 4 Maintenance of Certification (MOC)

QI Project Enrollment Form

Complete the information below to request enrollment in a currently approved project. Completion of this form does not verify acceptance. You will be contacted by the project leader or the MOC Portfolio Administrator with additional information. Incomplete or insufficient information may delay approval for participation in the project. Please allow up to 1 week to receive a response regarding your form submission.

Currently Approved Large-Group Projects

Project	Enrollment Cut-Off Date
Antiobiotic Stewardship	Closed
Appendicitis Care Map	Closed
Asthma Care Map	Closed
Bronchiolitis Care Map	Closed
Cellulitis/Abscess Care Map	Closed
Croup Care Map	Closed
Pneumonia Care Map	Closed

Click here for relevant MOC opportunities originating from other portfolio sponsors.

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* 1. Which project would you like to join?

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* 2. Please provide the following demographic information. Physician's date of birth (month and day) as well as first and last name must match ABP records exactly to receive points. Every ABP Board certified physician has a unique, ABP ID number. Physicians who do not know their ABP ID can look it up on the ABP website: https://www.abp.org/content/verification-certification.

First Name

Last Name

Degree and Credentials

Email Address

Phone Number

Practice/Organization Affiliation

ABP Diplomate ID #

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* 3. Would you like to be added to the CME mailing list?

Yes

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* 4. MOC project participation at ETCH requires completion of the Institute for Healthcare Improvement (IHI) Open School Online Course: QI 102: How to Improve with the Model for Improvement.
Click here for instructions on accessing this FREE online course.

I have already submitted my certificate of completion.

I will attach my certificate of completion to this form.

I will email my certificate of completion to the MOC Project Administrator later. I understand that submitting my certificate of completion is required for project participation.

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* 5. Upload your IHI QI 102 certificate of completion.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File

Contact the MOC Portfolio Administrator with any questions: Anna McKay, 865-541-8149, amckay@etch.com

Question Title

* 1. Which project would you like to join?

Question Title

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* 3. Would you like to be added to the CME mailing list?

Question Title

* 4. MOC project participation at ETCH requires completion of the Institute for Healthcare Improvement (IHI) Open School Online Course: QI 102: How to Improve with the Model for Improvement. Click here for instructions on accessing this FREE online course.

Question Title

* 5. Upload your IHI QI 102 certificate of completion.

* 4. MOC project participation at ETCH requires completion of the Institute for Healthcare Improvement (IHI) Open School Online Course: QI 102: How to Improve with the Model for Improvement.
Click here for instructions on accessing this FREE online course.