CSHP CE Program: Practices in Opioid Stewardship

Attendee Information

Completion of this program evaluation for "Practices in Opioid Stewardship" CE offered by CSHP: Completing this survey is required in order for CPA to upload your credit to NABP. You will only receive credit for those programs for which you fully attend and have provided the correct program code.

* COMPLETE ALL FIELDS Please fill in every box. Do not leave boxes empty. If you don't have a company name retype your name or indicate practice status (i.e. retired)

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* 1. Please enter complete information and double check for accuracy to ensure you receive your statement of credit.

Name: *

Hospital: *

Address: *

Address 2:

City/Town:

State: *

ZIP: *

Email Address: *

Phone Number: *

CAUTION: When entering your NABP e-profile ID and date of birth make sure to double check your response for accuracy. Incorrect information that leads to failure of submission may result in monetary fees.

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* 2. Please enter your NABP e-Profile number for the CPE Monitoring Program exactly as requested below. Please double check your response for accuracy.

NABP e-profile ID (6-10 digits) or enter 0 here if you do nothave your NABP e-profile ID

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* 3. Please enter your DATE OF BIRTH information for the CPE Monitoring Program in day/month format (no year!!). You are responsible for the accuracy of this information.

For Example: 0709 for July 9th

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* 4. Please specify whether you are a:

Pharmacist

Pharmacy Technician