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Continuing Medical Education

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					                                   Continuing Medical Education
                                         University of Virginia
                              Checklist for Regularly Scheduled Activities



          Title of Program Series:___________________________________________________________

          Date:___________________________________________________________________________

          Speaker(s):______________________________________________________________________

          Topic:___________________________________________________________________________


PLEASE SEND PRIOR TO ALL ACTIVITIES:

          Signed Faculty Disclosure On file with CME       or    Date sent to CME___________________

          Is the presenter UVA            Non-UVA  Please attach CV for non-UVA presenters
          Learning objectives  (on Flyer or e-mail announcement)

          Copy of presentation 

          Letter of Agreement for Commercial Support (if applicable) 


PLEASE SEND IMMEDIATELY AFTER ALL ACTIVITIES:

          Participant spreadsheet (along with a copy of the flyer) 

          Verification of Disclosure form 


OUTSIDE SPEAKER INFORMATION:

          Did the presenter receive an honorarium and/or travel expenses?   Yes  No 

          If yes, did the funds come from: Department/divisional account  Pharmaceutical Company 
          Budget (please list amount of grant, honorarium, travel & other expenses)
              Required, whether Dept./Div. funds or commercial support

				
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