Community Hospitals Making Reports To The DCF Child Abuse Care-line
1.
Name:
 

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2.
Occupation:
MD
PA
APRN
RN
LPN
Social Worker
EMS Provider
Other  
3.
Are you requesting CME or CEU's?
Yes - CME
Yes - CEU
No
4.

Hospital/Organization:

 

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5.

Email Address: 

 

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6.
CONTENT
 Strongly Agree Agree Disagree Strongly Disagree  
Was organized and easy to follow  
Met the objective(s)  
7.
TRAINER
 Strongly Agree Agree Disagree Strongly Disagree  
Knows and understands the topic  
Was well organized and prepared  
Was clear and easy to follow  
8.
RELEVANCE - as a result of this training...
 Strongly Agree Agree Disagree Strongly Disagree  
I gained factual information  
I gained a better understanding of topic  
I have developed more skills and competencies  
9.
Required for Physicians, PA's, APRN's, Requesting CME's
This was a quality CME activity and met the following objectives:
 Strongly Agree Agree Disagree Strongly Disagree  
Gave care-line specific information  
Understand what kind of information the Child abuse Care-line is looking for from Ed providers  
Understand decision making safety plan  
  • Comment:

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10.
Required for Physicians, PA's, APRN's, Requesting CME's
Please Rate the Following Statements
 Strongly Agree Agree Disagree Strongly Disagree  
This CME activity will favorably influence my ability to practice medicine as a leader, teacher and researcher  
The program clearly indicated whether or not this CME activity received commercial support  
I observed no overall commercial bias in this educational session  
I would definitely recommend this CME activity to my colleagues  
  • Comment:

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11.
Please estimate the number of infant and children that you see in a month with suspected child abuse and/orĀ neglect:

 

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12.
What did you like best about this session?

 

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13.
What did you like least about this session?

 

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14.
Suggestions for Future Clinic Topics:

 

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