QI/Part IV MOC
Interest Form

There are numerous ways to be connected to the mission of the Ohio AAP – to improve the health and well-being of Ohio’s children. Now is a great time to get involved in an area that YOU are passionate about!
Currently, we are offering four FREE QI/Part IV MOC programs to our members, and to serve you better in the future, we are gathering information about your potential interest in QI programs.
To find out more information and get involved today, please complete this form, or contact our Executive Director, Melissa Wervey Arnold at 614-846-6258 or marnold@ohioaap.org

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* 1. Please provide contact information.

Name:

Company:

Address:

Address 2:

City/Town:

State:

ZIP:

Email Address:

Phone Number:

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* 2. What is your recertification date?

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* 3. Do you have a subspecialty? If so, in what area?

Yes

Subspecialty:

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* 4. In what current QI programs are you interested?

Pound of Cure Learning Collaborative - Eligible for 25 ABP MOC points

Injury Prevention Learning Collaborative - Eligible for 25 ABP MOC points

Chapter Quality Network Asthma Project - Eligible for 40 ABP MOC points

Building Mental Wellness Learning Collaborative - Eligible for 25 ABP MOC points

Question Title

* 1. Please provide contact information.

Question Title

* 2. What is your recertification date?

Question Title

* 3. Do you have a subspecialty? If so, in what area?

Question Title

* 4. In what current QI programs are you interested?

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* 5. In what other areas would you be interested in having QI programs, and how would you like to be involved?