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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
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)
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.
DEMOGRAPHICS. Specialty:
Anesthesiology
Family practice
Internal medicine
Neurology
Pain medicine
PM&R
Primary care
Psychiatry
Other (please specify)
DEMOGRAPHICS. Practice setting:
Outpatient
Hospital
Medical school
Group private practice
Solo private practice
Other (please specify)
