University of Kansas Health System Continuing Medical Education Checklist

University of Kansas Health System Continuing Medical Education Checklist

This mandatory form will assist you in planning, implementing and evaluating your activity. Failure to complete the form may result in no Continuing Medical Education credit being awarded for the activity.
ACTIVITY INFORMATION
Title of Continuing Medical Education Activity:*
Date of Activity:*

MonthDayYear
Date
Please select the type of activity :

Grand RoundsJournal ClubCase ConferenceM&M
Activity Coordinator Name:*

First NameLast Name
Activity Coordinator E-Mail:*
example@example.com