CE/CME Satellite Lunch Symposium Evaluation
Pain Management & Opioid Prescribing: Protect Patients & Improve Outcomes

Wednesday, September 7, 2022
The Cosmopolitan of Las Vegas

Credit Application

Question Title

* Contact details:

First Name

Last Name

Degree(s)

Email (to receive your certificate of credit)

Phone Number (if we need to reach you regarding your credit)

Question Title

* Credits claimed

AMA PRA Category 1 Credit(s)™:
Please write below the total amount of credit claimed for this activity (not to exceed 1.0 credits)*

ACPE continuing pharmacy education credits:
Please write below the total amount of credit claimed for this activity (pharmacists only) (not to exceed 0.1 CEU)†

PHARMACISTS ONLY:
Please provide you NABP number. Credit cannot be uploaded to CPE Monitor without this.

PHARMACISTS ONLY:
Please provide your Date of Birth in MMDD format number. For example, 0130. Do not provide year of birth. Credit cannot be uploaded to CPE Monitor without this.

*One (1) credit for each hour of participation
†0.1 CEU for each hour of participation

By submitting this evaluation form, I certify that I completed the live activity, Pain Management & Opioid Prescribing: Protect Patients & Improve Outcomes.

AMA PRA Category 1 Credit(s)™: Certificate of Credit will be emailed within 4 weeks of successful completion of the activity.
ACPE continuing pharmacy education credits: Credit will be uploaded to CPE Monitor at the beginning of each month.

Question Title

* DEMOGRAPHICS. Specialty:

Anesthesiology

Family practice

Internal medicine

Neurology

Pain medicine

PM&R

Primary care

Psychiatry

Other (please specify)

Question Title

* DEMOGRAPHICS. Practice setting:

Outpatient

Hospital

Medical school

Group private practice

Solo private practice

Other (please specify)