Responsibilities of the ED provider after a DCF referral has been made
1.
Name:
 

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2.
Occupation:
MD
DO
PA
APRN/RN
LPN
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.
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  
Understand the responsibility of the ED provider once a report has been made to child protective services  
Understand how protected health information can be shared with CPS and law enforcement  
How to write affidavits  
Understand your roll in testifying in court  
  • Comment:

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9.
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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10.
What did you like best about this session?

 

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11.
What did you like least about this session?

 

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12.
Suggestions for Future Clinic Topics:

 

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