CONTINUING MEDICAL EDUCATION (CME)

							                                   CME ACTIVITY EVALUATION FORM


                                               AMA HIPPA School

                                          HIPAA Security Compliance

As a result of participating in this activity, I am able to:

 Institute HIPAA Security procedures at your practice that                Disagree                        Agree
 comply with the new regulations                                             1     2          3      4      5
 Understand HIPAA security rule administrative, physical, and             Disagree                        Agree
 technical safeguards for electronic protected health                        1     2          3      4      5
 information (ePHI)

 Recognize the HITECH Act breach notification guidance on                 Disagree                        Agree
 securing ePHI                                                               1     2          3      4      5

 Identify the enforcement of and penalties for noncompliance              Disagree                        Agree
 with the HIPAA security rule                                                1     2          3      4      5



 As a result of participating in this educational activity:
          I will change my practice.                      How?



          I will not change my practice.                  Why?    This activity reinforced my current practice.
                                                                  Other (please explain):




 Overall, I would rate this activity:                                     Poor                           Excellent
                                                                            1        2        3      4       5

 Other comments, suggestions or recommendations for future activities:




In order to receive AMA PRA Category 1 Credit ™ for this activity please submit this evaluation along with
your credit claim form by fax, e-mail or standard mail to the following:

American Medical Association
Attn: Debbi Smith
515 N. State Street
Chicago, IL 60654
Fax (312) 464-4623
amahipaaschool@ama-assn.org