Fluoride Varnish for the Medical Team (Enduring Materials) Survey

1.Demographics(Required.)

First Name

Last Name

ABP ID

Birthday (Month/Date)

Email Address:

2.I give permission to the New Jersey Chapter, American Academy of Pediatrics, to share my completion data (first/last name, month/day of birth, ABP ID and date of completion) with the ACCME and ABP for purposes of reporting my MOC Part II credit. (Please note: If permission is not granted, you will not receive MOC Part II credit through the ABP.)(Required.)

I give permission

I do not give permission

3.Are you seeking CME/MOC pt 2 for your participation?(Required.)

Yes

No

4.“I attest that I participated in and completed the educational activity as indicated and understand that continuing education credit is awarded based on this attestation.”

Yes

No

5.How valuable was the activity to your practice?(Required.)

Very valuable

Somewhat valuable

Not at all valuable

7.Was this session free of any commercial bias?(Required.)

Yes

No

If not, please specify why:

9.What is one new thing you learned from this activity?(Required.)

10.As a result of this session, I am going to make the following changes in my practice:(Required.)

11.Varnish applications can be provided by any staff member.(Required.)

True

False

12.The CPT code for the application of fluoride varnish is:(Required.)

0792T

99188

92507

There is not CPT code

13.The ADA recommended patients that are moderate risk for caries should receive fluoride varnish applications every _________ months.(Required.)

3

4

6

12

14.Patients can eat/drink immediately after ALL fluoride varnish applications.(Required.)

True

False

Depends on the varnish you are using. Follow manufacturer's instructions.

None of the above

15.Would you be interested in setting up an in-office 15 minute training?(Required.)

Yes

No

16.Additional Feedback: