Documentation of RSS Form by naq52275


									                          Facility                       OCE File                      Title of Activity

                                       Sponsorship Period:

                                              INDIAN HEALTH SERVICE
                                                 Clinical Support Center
                                             Office of Continuing Education
                                 40 North Central Avenue, Suite 780, Phoenix, AZ 85004

Title of Presentation:

Date of Presentation:                                                 and Time:                            to

Presenter’s Name/Degree:                                              and Job Title:

Presenter’s Worksite:
Staff Present: Attach a TYPED sign-in sheet to verify attendance for CE credit (must include full name,
               credentials/profession, and last four digits of SSN).

Needs Assessment: Select the sources of how the needs for this presentation were determined:
     Evaluations of prior CE activities                                  GPRA measurements
     New medical/nursing/pharmacy knowledge                              Hospital Committee data or findings
     Patient care audit data                                             IHS or Area Office priority or initiative
     Practice profile (frequency of common diagnoses or conditions)      Gap in Knowledge, Competence, Performance
     Program priority
     Other (Describe):
Objectives: At the completion of this CE activity, the participants will be able to:




     The Indian Health Service (IHS) Clinical Support Center is accredited by the Accreditation Council for
     Continuing Medical Education to sponsor continuing medical education for physicians.

     The IHS Clinical Support Center designates this educational activity for one hour of AMA PRA Category 1
     Credit™ for each hour of participation. Physicians should only claim credit commensurate with the extent
     of their participation in the activity.

     This Category 1 credit is accepted by the American Academy of Physician Assistants.

     The Indian Health Service Clinical Support Center is accredited as a provider of continuing education in
     nursing by the American Nurses Credentialing Center Commission on Accreditation. This activity has
     been awarded            contact hours (which includes             hours of pharmacology).

           __________________________                                   ____________________________
                 John F. Saari, MD                                          Lisa A. Palucci, MSN, RN
                Physician Educator                                               Nurse Educator

     Last Updated: September 2009

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