Checklist

RMC CME Checklist

This mandatory form will assist you in planning, implementing and evaluating your activity. Failure to complete the form may result in no CME being awarded for the activity.
Title of CME Activity:
Grand RoundCase ConferenceM&M
Date of Activity:

MonthDayYear
Contact Person for Activity:

First NameLast Name
Contact E-Mail Address

DURING THE ACTIVITY
Planners/Planning CommitteeModeratorSpeaker/Faculty
Accreditation Statement and Disclosures are made available in writing to all attendeesAttendees sign name in appropriate boxAttendees indicate if they desire CME/CE or noneAttendees complete/verify or update e-mail address as neededAttendees claim time commensurate for participation in the activityN/A: Credit Claimed Online by all participants
8. Educational Reporting (Only for Case Conferences and Morbidity & Mortality Activities)
8-a. Medical Issue Captured as identified by specific case(s) selected:
8-b. Outline of discussion (simple notes from meeting that does not include identifying patient information):
8-c. Educational take-away point(s) from discussion of patient case(s), including adverse outcomes &/or death:
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RMC CME Checklist