CO-PILOT™ Point of Care Online Credit Submission Form

Complete and submit this form to apply for .5 credit hours of AMA PRA Category 1 Credit™. Upon acceptance of this activity by the France Foundation, you will receive a certificate documenting your successful completion of this activity. Please note that all three questions and the activity evaluation form must be completed to receive credit.

* = required fields
Participant information
*First Name:
*Last Name:
*Please indicate your degree(s): MD DO PharmD APRN
PA Other:
*E-mail:
*Address:
 
*City:
*State:
*Zip:
*Phone:
*Fax:
 
*1. Point of Care CME Question
Please enter your clinical question:

 
*2. Please identify the sources/references that you consulted:

 
*3. Please describe the application of your findings to practice:
Confirmed a diagnosis
Applied new clinical guidelines to practice
Reviewed a condition not managed recently
Other
 
Evaluation
1. Please rate the effectiveness of this Point of Care activity.
1 – Very Ineffective   2 –Ineffective   3 –Effective   4 – Very Effective
Ease of use 1 2 3 4
Available references 1 2 3 4
2. Did the activity meet your learning objectives?
Not at all met Partially met Met Thoroughly met
3. Will you apply the information in your clinical practice?
Yes No Not sure
 
 
 
 

 
 

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