Pediatric Cardiology Template - DOC

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					                                        The American Board of Pediatrics
                                             Maintenance of Certification
                              Portfolio New Project Notification Template

                     Template for Newly Approved Project Notification (To ABP)

Quality Improvement
Project Title

Project Start Date

Project End Date

Date Project Approved for
MOC

Project Leader

QI Project Contact (to be
listed on ABP website)

Phone

Email

Relevant Pediatric Specialties Choose all that apply.

  General Pediatrics                                    Pediatric Emergency Medicine
  All Specialties                                       Pediatric Endocrinology
  Adolescent Medicine                                   Pediatric Gastroenterology
  Child Abuse Pediatrics                                Pediatric Hematology-Oncology
  Developmental-Behavioral Pediatrics                   Pediatric Infectious Diseases
  Hospice and Palliative Medicine                       Pediatric Nephrology
  Hospitalist                                           Pediatric Neurology
  Medical Toxicology                                    Pediatric Pulmonology
  Neonatal-Perinatal Medicine                           Pediatric Rheumatology
  Neurodevelopmental Disabilities                       Pediatric Transplant Hepatology
  Pediatric Cardiology                                  Sleep Medicine
  Pediatric Critical Care Medicine                      Sports Medicine
ABP Pediatric Portfolio Sponsor Standards & Requirements   Page 2 of 2

				
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Description: Pediatric Cardiology Template document sample