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UNIVERSITY OF OKLAHOMA HEALTH SCIENCES CENTER_ COLLEGE OF MEDICINE

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UNIVERSITY OF OKLAHOMA HEALTH SCIENCES CENTER_ COLLEGE OF MEDICINE Powered By Docstoc
					                   Application for CME Credit and the Documentation Review of a CME Activity
                                                                       (OU/CME Website: http://cme.ouhsc.edu)
Dear Course Director,

In preparing an application for a CME activity, it is imperative that the applicant follow the Accreditation
Council for Continuing Medical Education (ACCME) requirements. Periodically the University of Oklahoma
College of Medicine CME Office is surveyed by the ACCME. As part of the survey, the Documentation
Review is an opportunity for ACCME surveyors to assess the performance in practice of the CME provider
with respect to the planning and presentation of CME activities. As you prepare your application please
keep in mind that in order for the CME Office to maintain its ACCME accreditation, your activity file must
meet the requirements listed below.

THE DOCUMENTATION FOR ALL ACTIVITIES REVIEWED BY THE ACCME MUST SHOW THAT…
 A planning process was used that linked the identified educational needs and learning gaps of the
   target audience with a desired result. An educational need is the gap between “what is” (current practice)
     and “what could be” (best practice).
    Multiple needs assessment data were used to plan the activity (required minimum of 2).
    The purpose/objectives of the activity were communicated to the learner prior to the activity through
     an announcement and printed in the syllabus/handout.
    The activity was evaluated in terms of the effectiveness in meeting the identified needs and learning
     gaps.
    All printed materials for the activity carry the appropriate accreditation statement for AMA PRA
     Category 1 Credit(s)™.
    All faculty or planner relationships were made known to the participants.
    All the recommendations involving clinical medicine in a CME activity are based on best evidence
     accepted within the profession of medicine (as adequate justification for their use to improve the care
     of patients).
    Signed agreement(s) between the provider and the commercial supporter(s) are present.
    Faculty and planner relationships with commercial supporters were disclosed to learners via listing in
     the printed syllabus/handout.
    Acknowledgment of commercial support occurred.
    All conflicts of interest have been identified, reported to and resolved by the CME Office and
     communicated to the audience.
    The OU/CME honoraria policy (application form, page #12) is adhered to.
    No product-promotion or product specific advertisements are juxtaposed with educational materials or
     sessions.

Thank you for your cooperation and willingness to help the CME Office remain compliant with the ACCME.
The ACCME Essentials Elements and Policies are found on our web site. (http://cme.ouhsc.edu,
application tab, section I, B, #3 & section II, A, #3).

Five selections are available from the University of Oklahoma College of Medicine Office of Continuing
Medical Education and the fees are based on the type of activity you are developing and the services you
desire. You can review administrative fees and the administration of duties for your selection within this
application form on pages 6, 13-16. If you have questions about the packages, please call 405-271-2350
or 888-682-6348.

A complete application must contain:
                        1.    Application form
                        2.    Multiple support documentation verifying needs and learning gaps
                        3.    Activity information form (please supply all the requested information)
                        4.    CV’s from the planning committee members, speakers,
                                 moderators, panelists, residents and abstract presenters
                        5.    Completed disclosure forms from planning committee members, speakers,
                                 moderators, panelists, residents and abstract presenters
                        6.    Commercial support information form (please supply all the requested information)
                        7.    Application fee
                        8.    Proposed budget required for commercially supported activities
                        9.    Brochure/flyer/announcement draft
                       10.    Detailed agenda


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                                                                                             CME# ______________________
                                                                                                         (To be assigned by the CME Office)
           UNIVERSITY OF OKLAHOMA COLLEGE OF MEDICINE
           IRWIN H. BROWN OFFICE OF CONTINUING MEDICAL EDUCATION

                                                       CME ACTIVITY APPLICATION

Application Instructions: This application is designed to meet the requirements of the Accreditation
Council for Continuing Medical Education (ACCME) in sponsoring educational activities where AMA PRA
Category 1 Credit™ is desired. Please complete all appropriate sections of the application, as failure to do
so will delay the application process.
Applications for live or enduring material activities must be submitted, reviewed and approved prior to
printing of brochure or announcement. Application approval received less than 45 days before the activity
will incur additional late fees. Enduring materials applications received in the CME Office after the
enduring material has been printed or published cannot be considered. Regularly Scheduled Conferences
must be approved before the first activity occurs. (If an application form is submitted and a request for
additional materials is later requested, you must submit that material within 10 days.) OU/CME reserves
the right to decline belated application submissions.
Please review all application documents listed on the web site http://cme.ouhsc.edu . Once you have
completed the application form, please submit it to Myrna-Page@ouhsc.edu or call (405) 271-2350, ext. 3,
if you have questions.

GENERAL INFORMATION FOR ALL ACTIVITIES
Instructions: Use TAB COURSE DIRECTOR                                                PLANNER/CONTACT PERSON
KEY to move within
document
1      Name
2      Department
       or Company
       Name
3      Address

4      Telephone #
5      Fax #
6      E-mail Address
7      New Repeat               Please indicate if this is a new or repeat CME activity. (First offering or annual occurrence)

8         Yes         No        Is this a series? (The same agenda repeated during the fiscal year)
9      Sponsorship                An activity organized by departments within the OU College of Medicine is directly sponsored; if
                                  organized by entities outside the OU College of Medicine, it is a jointly sponsored activity. Is
                                  this a directly or jointly sponsored activity?   Directly       Jointly
10     Type of                       Live course (symposium, workshop, conference)         Internet, Live       Other_______
       Activity
                                     Enduring Material - specify type: __Home study __ Online __CD-Rom __ Monograph __
                                  DVD’s Other_______________________.
                                  (If this box is checked see additional guidelines under Policies, application form, page 9-10).

                                     Regularly Scheduled Conference (RSC) __grand rounds __journal club __research
                                  conference __Other__________________________________________________________
                                  (If this box is checked see additional guidelines under Policies, application form, page 9).
11     Activity Name

12     Start Date                                End Date             If this is a RSC, what is the scheduled day of         RSC meeting
                                                                                    M, T, W, TH, or 
                                                                      the week:                       F.                 times of the
                                                                      Frequency:    Monthly   Weekly   Quarterly          day?
                                                                      Other___________________________                      ____to ____
13     Facility/Location
       (If applicable)
14     Facility
       Address
       (If applicable)            (Street)                            (City)                            (State)     (Z ip)

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15     Target Audience            Expected audience size_____ Percent of audience expected to be physicians_______
16     Specialties                List specialties of the target audience:


17     Other credits              Are you applying for other credits such as AAFP, ACOG, CRNA, etc.? Yes No
                                  Which types? _______________________________________________________________
18     Promotion                  Do you want your activity on the CME web page? http://cme.ouhsc.edu               Yes      No
19     Announcements              Please enclose a draft announcement showing the program objectives, accreditation statement, conflict
       and Approval               resolution statement, accommodation statement and commercial support. (samples, http://cme.ouhsc.edu,
       Information                application tab, section I, B, #9 & section II, A, #6.) The ACCME requires specific wording on the
                                  announcement that OU/CME must approve prior to printing. All types of activities must provide a link or
                                  a file containing your brochure or announcement for placement on the OU/CME webpage. Regularly
                                  scheduled conferences enclose a sample announcement (monthly calendar, etc.). Enduring materials
                                  include all promotional materials (flyer, brochure, introductory letter, etc.). See checklists under the
                                  enclosed policies (application form, page 9-10.)
20     AMA PRA                    Will this program teach new procedures and skills which may allow for expanded clinical
       Credit Levels              privileges?      No    Yes If yes, please note that the AMA has established a system of four
       for New                    levels that reflect the education and training a physician has achieved in the new procedure.
       Procedures                 (Levels 2-4 require additional instructions and feedback from the course director.)
       and Skills                 The four levels are:
                                  Level 1. Verification of Attendance;
                                  Level 2. Verification of satisfactory completion of course objectives;
                                  Level 3. Verification of proctor readiness; and
                                  Level 4. Verification of physician competence to perform the procedure.
                                  CIRCLE the level appropriate for this activity.
21     Presenters,                On the Activity Information Form, (application form, page 7) please submit presenters,
       Course Director,           course directors, committee members, moderators, abstract presenters, residents &
       Committee                  panelists’ names along with:
       Members                        Addresses and e-mails
                                      Telephone and fax numbers
                                      Amount of honoraria (if applicable)
        (Includes planning            If expenses are being paid
       committee
                                      Completed disclosure forms
       members,
       moderators and                 Social security numbers, if OU/CME is paying the speakers
       panelists).
                                  Please enclose a biographical sketch or curriculum vitae (CV) for each of your off-campus
                                  program speakers. Speakers from OUHSC do not have to submit CVs.
22     Disclosures                ACCME requires documentation to show that relationships with commercial supporters are
       for Presenters,            disclosed to the participants even if there is no commercial support associated with this
       Course                     program. Documentation must be sent to CME, this includes relationships planning committee
       Directors, and             members, moderators and panelists have as well as all your presenters. (See application form,
       Planning                   page 7.)
       Committee
       Members                    Disclosure is a two step process: The 1st step is collecting the disclosure information form from
                                  each planner/presenter (Disclosure form, http://cme.ouhsc.edu, application tab, section I,
                                  B, #11) and the 2nd step is conveying the disclosure information obtained to your activity
                                  participants. This is accomplished by adding a disclosure report to your printed
                                  handout materials or syllabus. (Disclosure report, http://cme.ouhsc.edu, application tab,
                                  section I, B, #16.)

                                  What other methods of disclosure do you intend to use?
                                     Moderator or presenter will verbally disclose at the beginning of each presentation
                                     Will post via a POWERPoint slide or an overhead
                                     RSC sessions: Printed on RSC Flyer and listed on RSC Evaluation/Attendance Form (See
                                  disclosure report, http://cme.ouhsc.edu, application tab, section II, A, #6 & #13.)
23     Commercial                 Will this activity involve commercial support from manufacturers, pharmaceutical companies,
       Support                    etc., for speakers, lunches, etc.? If yes, please submit names, copies of your letter of request,
                                  addresses including telephone and fax numbers, and dollar amounts, if known, from each
           Yes        No
                                  commercial supporter on the Commercial Support Information Form. Exhibitors are considered
                                  commercial supporters. (See application form, page 8.)
24     Activity                   Please list member names and titles:
       Planning
       Committee


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25     Educational                What are the problems/needs/gaps of the target audience that this activity will address?
       Needs and                  (Summarize why this continuing medical education activity is needed.) For medical conditions
       Learning Gaps              and practice activities relevant to this target audience, the target audience needs:
       Addressed
       by this                    Patient Care
       Activity                           Diagnosis                                      Treatment
                                   review of established methods           review of established methods
                                   information on new methods              information on new methods
                                   new or improved skills                  new or improved skills
                                  Medical Knowledge Advancement
                                   review of knowledge base generally recognized as current and applicable
                                   information on new findings in basic or clinical sciences
                                   information on how to perform medically related research
                                   new or improved skills in performing medically related research
                                  Practice Based Learning and Improvement
                                   information on the extent to which recommended care is not being provided
                                   information on how to evaluate scientific evidence and or improve personal practice
                                   new or improved skills to evaluate scientific evidence and or improve person practice
                                  Interpersonal and Communication Skills
                                   information on methods to improve interpersonal relationships and communication
                                   new or improved interpersonal and communication skills
                                  Professionalism
                                   information on medical ethics, professional responsibilities, medico legal issues and/or
                                     sensitivity to a diverse patient population
                                   new or improved skills regarding medical ethics, professional responsibilities, medico legal
                                     issues and/or sensitivity to a diverse patient population
                                  Systems-Based Practice
                                   information on practice management
                                   new or improved management/administrative skills
                                   information on multi-specialty/multidisciplinary coordination of care
                                  Other (Summary Required)
                                  


26     How were                   What information and/or data did you use to determine the need/gaps for this program by your
       Needs                      target audience? To show how needs were determined you must enclose documentation.
       Determined                 This application will not be considered if at least two needs sources are not used and if
       (Documentation is          data sources are not attached. (Check all that apply).
       required)
                                  ___Patient care audit              ___Physician survey         ___Review/update
                                  ___New technique/material         ___Quality Assurance         ___Epidemiological Data
                                  ___Search of current literature   ___Evaluations of previous programs
                                  ___Planning Committee minutes ___Advice from authorities from the field
                                  ___National and/or regional and/or state health statistic data ___Other (specify)_______
                                  _________________________________________________________________________

                                  a. Did you consider the physician scope of practice in your planning process?        Yes     No
                                     (i.e. rural or urban, solo or multi practice, hospital or university based practice, etc.)
                                  Explanation required:______________________________________________________
                                  _________________________________________________________________________

                                  b. Does your content relate to an Institute of Medicine, Accreditation Council for
                                     Graduate Medical Education, or other competency or other desirable physician attribute?
                                  Explanation required:__________________________________________                    Yes No
                                  _______________________________________________________________________________________

                                  c. Do you have access to or know about any non-educational strategies to complement
                                     this activity’s educational efforts? (i.e., screening tools, list of resources) Yes No
                                  Explanation required:________________________________________________________
                                  _________________________________________________________________________




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27     Objectives                 The learning objectives must be listed in all promotional materials including brochures, syllabus,
                                  flyers, and website listings, on announcements or on web calendars. For help with writing
       Objectives                 objectives, (see http://cme.ouhsc.edu, application tab, section I, B, #8 or section II, A, #2).
       Con’t                      You must use action verbs that are measurable like those listed within this document. List your
                                  objectives - Upon completion of this activity, the participant should be able to:
                                  1.

                                  2.

                                  3.
                                  (May attach objectives, if easier.)
28     Program                    How is this CME activity structured to achieve the overall learning objectives? Check as many as
       Structure and              apply:
       Content                    __Didactic presentation      __Hands-on workshop               __Homework Exercises
                                  __Demonstration              __Case Discussions                __Skills Testing
                                  __Panel Discussion           __Video-teleconference            __Small Group
                                  __Discussion                 __Procedure lab                   __Patient simulation
                                  __Reading Assignments        __Videodisk/Movie                 __Work on simulators/models
                                  __Q & A                      __Audience Response System __Online Library
                                  __Other_____________________________________________________________________

29     Evaluation                 Do you plan to use the CME Evaluation Form?     Yes    No If no, please enclose a copy of the
                                  evaluation form to be used. We have required evaluation questions that must be added to
                                  your evaluation form. (See questions, http://cme.ouhsc.edu, application tab, section I, B, #
                                  15 or section II, A, # 10 & #13.) Upon completion of the program, you must submit an
                                  evaluation summary to the CME Office.

                                  How will the evaluations be used? (Check as many as apply)
                                   The course director and planning committee will review the evaluations to determine
                                    whether objectives were met
                                   Feedback will be provided to the speakers
                                   Evaluations will be used in planning future CME activities (e.g. topics, speakers, format)
                                   Other:                                                                                 _______

30     Results                    What results or outcomes are expected from providing this activity? (Check all that apply.)
       And                        Patient Care
       Outcomes                    increased knowledge of diagnostic methods
                                   improved diagnostic skills
                                   increased knowledge of treatment methods
                                   improved treatment skills
                                  Medical Knowledge Advancement
                                   review of knowledge base generally recognized as current and applicable.
                                   increased knowledge of new findings in basic and clinical sciences
                                   increased knowledge of how to perform medically related research
                                   improved skills in performing medically related research
                                  Practice Based Learning and Improvement
                                   increased knowledge on how to evaluate scientific evidence and or improve personal
                                     practice
                                   improved skills to evaluate scientific evidence and or improve person practice
                                  Interpersonal and Communication Skills
                                   increased knowledge of methods to improve interpersonal relationships and communication
                                   improved interpersonal and communication skills
                                  Professionalism
                                   increased knowledge of medical ethics, professional responsibilities, medico legal issues
                                     and/or sensitivity to a diverse patient population
                                   improved skills regarding medical ethics, professional responsibilities, medico legal issues
                                    and/or sensitivity to a diverse patient population
                                  Systems-Based Practice
                                   increased knowledge about practice management
                                   improved management/administrative skills
                                   increased knowledge about multi-specialty/multidisciplinary coordination of care

                                   Other                                                                                 ______

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31     Feedback                   List all the suggestions from the past activity evaluation that you have incorporated in this new
                                  activity. (If this is a first time activity, list N/A.)


32     Five activity,             Payment must accompany the application. If off campus, please submit check made payable to
       pricing types              OU/CME, our Tax ID is 73 601 7987. OUHSC departments must pay by transfer. Our chart field-
       are listed                 spread information is: MISCA, COM015, 00014, 00000. Please send transfer copy with the
       below. Check               application referencing course number and title. A rush fee will be charged for application approvals
       your                       < 45 days plus an additional fee if approval is < 25 days before activity date. (Fee information,
       selection(s):              application form, pages 13-16.)
       1. Basic - Live            The course director handles all other aspects of the conference including handling registration
          Conference               etc. (Fee Information, application, pages 13-16)
       2. Registration            CME handles the pre-conference registration to include Online registration (optional). OU/CME
          - Live                  does not work the registration desk on-site; the course director is responsible for on-site
          Conference              management of the conference. (Fee information, application form, pages 13-16.)

          On-line                 Optional online registration - Check the on-line box if you want CME online registration from
          Registration            OU/CME, this service is free with the registration package.
       3. Series – Live           After selecting basic or registration package, your activity may be classified as a series when the
          Conference              same agenda is presented at various locations, with your application accreditation covering a 12-
          (Basic or               month period. The original application fee covers the first event, with each additional event
          Registration)           charged at the series rate, based on the package selection. (Fee information, application form,
                                  pages 13-16.)
       4. Regularly               An annual (grand rounds) application covers accreditation from July 1 through June 30. Rush fees
          Scheduled               do not apply because credit for your activity will begin on your application approval date. (Fee
          Conferences             information, application form, pages 13-16.)
       5. Enduring                Course Director handles the development of the educational materials. CME reviews the
          Materials               document for the required elements.
          CME On-line             If you wish to have your enduring materials hosted on the CME website – check the on-line
          Hosting                 hosting box, additional fees will be charged.

                                  Enduring Materials Re-application Form can be found at:
                                  http://cme.ouhsc.edu/documents/endmatreappform2006.doc
33     Additional                 If you are choosing the registration package, please indicate the fees for each of the following:
       Registration               Physician_______ Residents _______ Faculty_______ PA_______ Nurses_______
       Package                    Other categories, list and please specify amount_________________________________
       Information                ___________________________________________________________________


By signing this application, I attest that this activity will follow the ACCME Essentials Elements and Policies to the best of my
ability and that I will pay the fees charged.


_______________________                        ________              __________________________________
Signature of Program Director                  Date                  Signature of Department Head or Designee        Date

(A graphic electronic signature is acceptable or E-mail the completed application and fax the signature page to 405/271/3087.)
Return fully completed form and all documentation to:      (FOR OFFICE USE ONLY)
 Irwin H. Brown Office of Continuing Medical Education
 800 N.E. 15th Street, Room 202, P.O. Box 26901, ROB 202
 Oklahoma City, OK 73126-0901, Phone (405) 271-2350, Fax (405) 271-3087


                              This course is approved for _______ AMA PRA Category 1 Credit(s)™.

                                                                                                      ____________________
                     Assistant Dean for Continuing Medical Education                                             Date

     Not approved for AMA PRA Category 1 Credit™ due to:                            __Insufficient time before activity presentation
          __Topics not within definition of CME                                     __ Other


Fee Included ___ Yes ___ No ___ N/A                               Paid by ____ Check or ____ Transfer

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                                                           Activity Information Form
The following information must be returned with your CME Application Form. Complete this form for each planning committee
member, course director, and presenter including moderators, panelists, and abstract presenters. (This form is referenced on questions
21 and #22 of the CME Application Form.) If you prefer, you can create your own form, but please include all the information listed
below.

Will you have Commercial Support for your activity? Yes__      No__ If there is no commercial support for the
activity, you reimburse the presenters and you can skip the questions marked with the double red asterisks (**).

**If there is commercial support for your activity, the funds must come to the CME Office, and the CME office
must reimburse presenters. Complete the questions marked with the double red asterisks (**).

Activity Title                                                                                       Course Date

                                                      Person                     Person                             Person
           SSN (required if
         receiving payment)
                   Name
                    Title
               Specialty
            Full Address

        City, State, Zip
          Telephone #
                  Fax #
        E-mail Address
         Secretary/Office
                 Contact
        **Honorarium No__ Yes__ Amount $_____                         No__ Yes__ Amount $______         No__ Yes__ Amount $_____

**Paying Expenses                     Yes__ No__ Direct billed__      Yes__ No__ Direct billed__        Yes__ No__ Direct billed__
CV Required of all non-               Is it attached to this form?    Is it attached to this form?      Is it attached to this form?
    OUHSC presenters                  Yes__ No__ OU Faculty__         Yes__ No__ OU Faculty__           Yes__ No__ OU Faculty__
         Completed                    Is it attached to this form?    Is it attached to this form?      Is it attached to this form?
   Disclosure Form                    Yes__ No __                     Yes__ No __                       Yes__ No __

                                                      Person                     Person                             Person
           SSN (required if
         receiving payment)
                   Name
                    Title
               Specialty
            Full Address

        City, State, Zip
          Telephone #
                  Fax #
        E-mail Address
         Secretary/Office
                 Contact
        **Honorarium No__ Yes__ Amount $_____                         No__ Yes__ Amount $______         No__ Yes__ Amount $_____

**Paying Expenses                     Yes__ No__ Direct billed__      Yes__ No__ Direct billed__        Yes__ No__ Direct billed__
CV Required of all non-               Is it attached to this form?    Is it attached to this form?      Is it attached to this form?
    OUHSC presenters                  Yes__ No__ OU Faculty__         Yes__ No__ OU Faculty__           Yes__ No__ OU Faculty__
         Completed                    Is it attached to this form?    Is it attached to this form?      Is it attached to this form?
   Disclosure Form                    Yes__ No __                     Yes__ No __                       Yes__ No __




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                             COMMERCIAL SUPPORT/EXHIBITOR INFORMATION FORM
The following information must be included and returned with your CME Application Form. (This form is referenced on question #23
of the CME Application Form.) If you prefer, you can create your own form, but in doing so, please include all the information listed
below. Will you have Commercial Support for your activity? __Yes or No__. If no, enter N/A in the first column.

If yes, all information must be included for each company, organization, etc., supporting your activity. Exhibitors are considered
commercial supporters. You must keep the CME Office updated as companies confirm or decline your request for grants and/or
exhibitors. Also, please submit copies of the letters of request you sent to commercial supporters for grants and/or exhibit space. For
OU/CME to sign a company’s LOA, the form must be negotiated between OU/CME, OU Legal and the supporting company’s legal
department. This can take numerous phone calls, emails and faxing between the legal departments often requiring verbiage changes
and deletions to reach consensus from all entities. Therefore, we are charging a minimal fee for each company’s LOA that must go
through this time consuming process. (See administrative fees, application form, page #13.)

Activity Title                                                                              Course Date                        _
                                                   Company                   Company                               Company
        Company Name
       Representatives
                  Name
       Representative’s
           Full Address

      City, State, Zip
        Telephone #
                Fax #
      E-mail Address
  Company Confirmed                   No__ Yes__ Amount $_____    No__ Yes__ Amount $______             No__ Yes__ Amount $_____

           Exhibitor Only             No__ Yes__ Amount $_____    No__ Yes__ Amount $______             No__ Yes__ Amount $______

                                                   Company                   Company                               Company
        Company Name
       Representatives
                  Name
       Representative’s
           Full Address

      City, State, Zip
        Telephone #
                Fax #
      E-mail Address
  Company Confirmed                   No__ Yes__ Amount $_____    No__ Yes__ Amount $______             No__ Yes__ Amount $_____

           Exhibitor Only             No__ Yes__ Amount $_____    No__ Yes__ Amount $______             No__ Yes__ Amount $______

                                                   Company                   Company                               Company
        Company Name
       Representatives
                  Name
       Representative’s
           Full Address

      City, State, Zip
        Telephone #
                Fax #
      E-mail Address
  Company Confirmed                   No__ Yes__ Amount $_____    No__ Yes__ Amount $______             No__ Yes__ Amount $_____

           Exhibitor Only             No__ Yes__ Amount $_____    No__ Yes__ Amount $______             No__ Yes__ Amount $______




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POLICIES: Regularly Scheduled Conference Information, (if applicable)
                       (Grand rounds, journal clubs, research conferences, etc.)
Commercial               The CME Office must be notified of ALL commercial support obtained during the year. This includes
Support                  commercial supporters paying for catering. Commercial Supporters cannot directly pay for anything.
                         Failure to notify the CME office could jeopardize our granting credit for your activity. Your
                         department/organization is responsible for the distribution of the paperwork when commercial
                         support is involved. Forward all completed paperwork to the CME office for processing. The
                         educational grant check must be made payable to OU/CME and the CME office must reimburse the
                         speaker's expenses and pay the honoraria. Checks must be deposited with CME within 24 hours of
                         receipt. You cannot solicit commercial support after the event has happened. Commercial support
                         Letters of Agreement must be signed and dated before the activity for you to keep and utilize the
                         commercial support funds for your activity.
Planning                 Every person on the planning committee, the course director, the course contact and all people on
Committee                the activity agenda must complete a Disclosure Form. The completed form for the CME organizers
Members,                 (i.e., course director, planning committee and course contact) must be submitted with the application
Speakers,                for approval. The forms for the speakers/presenters/moderators can be submitted with the activity
Moderators,              application or two weeks before the actual presentation for review and approval by OU/CME.
Panelist and             Disclosure information from the speaker/organizer disclosure forms must be printed on
Abstract                 your announcement and listed on your attendance/evaluation forms. Speakers and
Presenters               organizers with nothing to disclose must state they have nothing to disclose. (See sample
                         disclosure for RSC’s at http://cme.ouhsc.edu, section II, A, #6 & #13.)
Application              The regularly scheduled conference year is from July 1 - June 30. To receive credit for the full
Deadline                 year, your application must be submitted prior to your first activity. If additional information is
                         required before your activity can be approved, items must be returned within 30 days, or credit for
                         your activity will begin on the date the application is approved.
Reporting                Each July you must submit your year-end reporting to the CME Office. (http://cme.ouhsc.edu,
                         application tab, section II, A, #12.) This reporting includes:

                         1. A listing of the actual past topics and speakers; 2. An annual evaluation/survey summary;
                         3. Participant information reporting form including first, middle and last name, degree, address,
                         phone, fax, the total number of credits for each physician/participant and 4. A completed Verification
                         of Disclosure Form (VOD) with back-up documentation (See VOD, http://cme.ouhsc.edu, section II,
                         A, #9).
                         After the year-end reporting is complete, a course certificate will be created by the CME office for
                         each participant, indicating the number of credits earned for the year. The certificates will be given
                         to the course contact person for distribution to the physicians /participants. If participants need
                         credit information before the end of the year, contact the CME office.
POLICIES:               Enduring Materials Information and Checklist,                          (if applicable)
                        CME enduring materials are printed, recorded, or computer-assisted instructional materials
                        which may be used over time at various locations and which the materials, IN THEMSELVES,
                        constitute a planned activity of continuing medical education. Examples of such materials
                        for independent learning by physicians include: programmed texts, audio tapes, CD ROMs,
                        videotapes, Internet CME, DVD’s and computer-assisted instructional materials, which are
                        used alone or in combination with written materials. Not included are reference materials"
                        such as books, journals or manuals.
Enduring                  Design and use of enduring materials must be consistent with the sponsor’s overall CME Mission
Materials                    Statement and must be described as within the scope of the sponsor’s CME efforts.
Checklist                 Enduring materials must be based upon identified CME needs of given target groups of physicians.
                          The Course Director must develop explicit objectives for the enduring material and must
                              communicate these objectives to the prospective audience.
                          The medium, or combination of media, chosen by the Course Director must be consistent in
                             content and method with the stated objectives. The overall length of the recorded materials and
                             estimated study time for completing the activity should be specified.
                          A statement should be displayed that the CME activity was planned and produced in accordance
                             with the ACCME Essentials. (Use correct Conflict Resolution and Accreditation Statements with
                              the available number of credits).
                          Course Director must evaluate each unit of enduring material at least once every three years or
                             more frequently if indicated by new scientific developments.
                          The Course Director must demonstrate that findings from the evaluation process are used to
                              revise, update, or plan future versions of the enduring materials.
                          The date of original release and expiration must be prominently displayed in Arabic numerals
                             after the title, along with the most recent date of review and revision or approval, if applicable.

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Enduring                      The CME provider of enduring materials must have a mechanism to record and, when
Materials                      authorized by the participating physician, to verify participation.
Checklist                     In instances of Joint Sponsorship, an accredited sponsor must assume ongoing responsibility
Con’t                          for the planning, proper use, and evaluation of the CME activity. Planning includes
                               identification of the target physicians, the educational needs to be addressed, the
                               appropriate objectives, educational content, selection of media and faculty, and the
                               production quality. Proper use includes marketing, distribution, and establishing the
                               conditions for effective participation.
Communicate                   Target audience of physicians
this                          Needs addressed and specific learning objectives
information                   Topics and educational content
to                            Principal faculty, their credentials and disclosure statements
prospective                   Medium or combination of media used
participants                  Method of physician participation in the learning process
                              Date of original release, most recent review or update and the expiration date
                              Estimated time to complete the educational activity
POLICIES:               Information and Checklist for all Joint Sponsorship, (if applicable)
                        (A JOINT SPONSORSHIP INVOLVES AN ENTITY OUTSIDE THE OU COLLEGE OF MEDICINE)
The University of Oklahoma College of Medicine is accredited by the Accreditation Council for Continuing Medical
Education to sponsor continuing medical education programs for physicians. The ACCME requires that sponsors
maintain a high standard of quality in the development of continuing medical education programs. It is the
responsibility of the Irwin H. Brown Office of Continuing Medical Education to assure the ACCME standards are met,
including those pertaining to commercial support. If commercial support/exhibitor fees are solicited, the handling of all
funds is the responsibility of the CME Office.

The following guidelines are designed to assist organizations that desire the services of the Irwin H. Brown Office of
Continuing Medical Education in developing a jointly sponsored accredited program. Regarding joint sponsorship,
ACCME Policy 96-C-07 states:

The accredited provider shall accept responsibility that the ACCME's Accreditation Policies and Procedures
are met when educational activities are planned and presented in joint sponsorship with non-accredited
providers. The provider shall: 1) Provide written documentation that each jointly sponsored CME activity
was planned and implemented in compliance with the ACCME's Accreditation Policies and Procedures, and
2) Ensure that all printed materials for jointly sponsored activities carry the joint sponsorship
accreditation and conflict resolution statements.

THE FOLLOWING STEPS MUST BE TAKEN IN ORDER TO DO A JOINT SPONSORSHIP WITH THE CME OFFICE:
Step 1                Following contact with the CME Director or Associate Director, a program application must be
Contact Office of     submitted to the CME Office for review by the CME Director and approval by the Assistant
Continuing Medical    Dean for CME. Approval is based on meeting our CME Mission and adherence to the Essentials
Education (405-271-   and Standards of the ACCME. (Applications are available on the CME web site at
2350, ext. 3 or 5).   http://cme.ouhsc.edu, application tab, section I, A.)

Step 2                             Following the initial planning meeting, the CME office will determine our level of involvement.
Develop Course                     Regardless of the level of involvement, the University of Oklahoma College of Medicine must
Content and Submit                 be listed as a joint sponsor on all promotional materials. A statement of accreditation must be
Application including              printed exactly as follows: (Also see http://cme.ouhsc.edu, application tab, section I, B, #9.)
the Joint-sponsorship
Accreditation                      This activity has been planned and implemented in accordance with the Essential
Statement on                       Areas and policies of the Accreditation Council for Continuing Medical Education
Announcements                      through the joint sponsorship of The University of Oklahoma College of Medicine and
                                   <Insert name of non-accredited sponsor>. The University of Oklahoma College of
                                   Medicine is accredited by the ACCME to sponsor continuing medical education for
                                   physicians.

                                   The University of Oklahoma College of Medicine designates this educational activity
                                   for a maximum of __ AMA PRA Category 1 Credit(s)™. Physicians should only claim
                                   credit commensurate with the extent of their participation in the activity.

                                   The University of Oklahoma College of Medicine, Office of Continuing Medical
                                   Education has reviewed this activity’s speaker and planner disclosures and resolved
                                   all identified conflicts of interest, if applicable.



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Step 3                             To comply with accreditation, the program must have a program evaluation and certificates of
Implement the                      attendance. These will be prepared for you by the CME office and are included as part of your
Program                            application fee. (See sample, http://cme.ouhsc.edu, section I, B, #14 & # 15.)
Step 4                             Various outcome reports will be submitted to the CME office including evaluation results,
Review the                         participant data, attendance rosters, and recommendations for future programs. (OU/CME has e
Program/Evaluation                 required evaluation questions that must be added to your evaluation form. (See those
                                   questions on our website at http://cme.ouhsc.edu, section I, B, # 15.)
Checklist                          The following checklist will be helpful to you in meeting all the requirements needed for
For Joint Sponsorship              OU/CME to jointly sponsor your CME activity:

(Joint Sponsorship                 Application
involves an entity                        __ Develop physician learning gaps/needs assessment
outside the College of                    __ Prepare objectives with measurable verbs obtained from our writing
Medicine)                                         objectives worksheet
                                          __ Complete & submit application to CME Office
                                          __ Application fee (Payable to OU/CME)

                                   Speaker Information
                                         __ Curriculum vitas (CVs) for all non-OUHSC, speakers, moderators, panelists,
                                                 abstract presenters including addresses. Social security numbers are
                                                 needed, if speakers are being paid by OU/CME
                                         __ Honoraria amounts for each speaker and if expenses are being paid, if applicable
                                         __ Organizer and Speaker Disclosure Forms signed by each speaker, moderator,
                                                 panelists, course director and course contact (Required even if there is no
                                                 commercial support for the program)
                                         __ Copies of syllabus/handout that will be distributed to participants showing the
                                                 required speaker and planner disclosure report
                                         __ Speaker Information Form

                                   Brochure Information
                                         __ Draft of announcement for approval by CME (must be approved by CME before
                                                printing and distributing.)
                                         __ CME listed as a joint sponsor of the program
                                         __ Conflict Resolution Statement
                                         __ Accreditation statement must be printed as specified with number of credits listed
                                         __ Target audience
                                         __ Objectives listed on brochure
                                         __ Accommodations on the basis of disability statement
                                         __ Acknowledgment of commercial support

                                   Budget
                                               __ Projected budget of program

                                   Commercial Support
                                        __ Copy of Letter of Request and Agreement from sponsoring company
                                        __ Documentation of acknowledgment of support, (On announcement and handouts)
                                        __ Commercial Support Information Form

                                   Review of the Program
                                         __ Evaluation of Program (with required evaluation questions)
                                         __ Completed evaluations from participants, (If CME form is used)
                                         __ Summary of evaluations (If CME form is not used)
                                         __ Completed attendance certificates for those wanting CME credit
                                         __ Recommendations for future programs
                                         __ Participant data, attendee lists, etc.
                                         __ Syllabus/handout copy showing accreditation, accommodation and conflict
                                               resolution statements, faculty and planner disclosure report, objectives, and
                                               if applicable, acknowledgement of commercial support
                                         __ Completed Verification of Disclosure Form (VOD) with back-up documentation




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                                                  University of Oklahoma College of Medicine
                                            Irwin H. Brown Office of Continuing Medical Education

                                                                  HONORARIUM POLICY


In keeping with the requirements of section 3.7 of the Standards for Commercial Support of Continuing Medical
Education (CME) of the Accreditation Council for Continuing Medical Education (ACCME) and in an ongoing effort to
provide consumers of continuing medical education programs with objective and scientifically rigorous education the
Office of Continuing Medical Education has developed a honorarium policy. The University of Oklahoma College of
Medicine Office of CME acknowledges the valuable contributions made by our speakers to the development and
provision of continuing medical education activities.

An honorarium is a payment for services for which fees are not legally required and which does not require contract
agreement to be negotiated and formalized. Honoraria are paid to persons of scholarly or professional standing in
conjunction with an academic activity. Honoraria should recognize and stimulate University CME development. The
intent is to show appreciation for participation in University of Oklahoma College of Medicine educational activities and
events. Honoraria must comply with the Standards for Commercial Support of the ACCME and not influence the choice
of speaker or the content of the presentation.

The CME course director negotiates all honoraria fees. Prior to confirming any speaker for an activity, the course
director should discuss with any presenter whether an honorarium and expenses are required. A written confirmation
should follow any such conversation. The amount paid will vary depending on the activity and the requirements for the
faculty. Considerations for determining the honorarium include the speaker’s expertise and reputation, the number and
length of presentations, preparation and travel-time. If there are questions about appropriate honoraria, the course
director should consult with the Assistant Dean for CME. The Assistant Dean may challenge unusually high honoraria.
In compliance with the ACCME Standards for Commercial Support, no honoraria or reimbursements will be paid directly
by the commercial supporter(s) to a presenter.

Required documentation must be submitted before reimbursement. Non-University speakers must submit the OU payee
registration form, Honoraria/Speaker Fees Approval Form, CME speaker travel form, the Oklahoma State Form- Form 3,
original receipts, canceled checks, or credit card receipts. If original receipts are lost or unavailable, signed written
documentation requesting exceptions may be submitted in lieu of original receipts. This documentation should include
details of the cost and nature of the expense, and an explanation of why the original receipts were not submitted.
Requests that fail to document acceptable expenses may be refused. Original receipts will not be returned. Expense
reports will be processed in 15-20 working days.

Following the speaker’s presentation participant evaluation results will be returned to the CME office in order to evaluate
the effectiveness of the speaker for other activities.

If an offering is solvent by either grants or fees, the director may pay local faculty a small honorarium and/or a fee to
encourage authorship of a comprehensive handout covering the presentation. Larger honoraria especially those derived
from commercial support are discouraged.




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                                                    CME Administrative Fees – Jointly Sponsored Activities 07/01/2008
                                                                                (All activities developed outside the OU College of Medicine)

            Live Conference Packages –                                  Basic                Registration                      Series                          Regularly Scheduled             Enduring Materials
                                                                   Live Conference         Live Conference          Live Conference Package Fee                Activities Package Fee             Package Fee
               Regularly Scheduled –                                                                                                                              (Grand Rounds)               (CME on CD, DVD,
                                                                    Package Fee *           Package Fee *              (Basic or Registration)
                Enduring Materials                                                                                Application approval is for one year.                                        Monograph, Online,
                                                                                                                    To qualify as a series, the content      Annual Application Fee Covers            etc.)
                                                                    (See page two for       (See page two for
                                                                                                                       must be the same; additional              Accreditation From
                                                                   the Administration      the Administration
                                                                                                                     offerings can be held in different         July 1 through June 30
                                                                       of Duties)              of Duties)
                                                                                                                    locations, multiple times. For the
                                                                                                                    first offering, refer to the basic or
                                                                                                                   registration package fee*, for each
                                                                                                                  additional offering in the series, refer
                                                                                                                              to prices below.
 Fee for each Registrant (fee collected after the program)                $25                     $25                              $25                                   N/A                            $25
  (** Residents)
 CME Administrative Package Fee (submit fee with                        $1,500                  $2,500                 First offering see Basic or                    $1,000                          $2,000
 application)                                                                                                          Registration Package Fee*
                                                                                                                                                                  (Each Location)
                                                                                                                       (Each additional offering)
                                                                                                                         $300 each (Basic)                                                    $500 Reapplication
                                                                                                                      $750 each (Registration)
 CME Administrative Application Late/Rush Fee’s                     < 45 Days $500          < 45 Days $500           < 45 Days $500 Rush Fee                    N/A (Credit for your          < 45 Days $500 Rush
 (A rush fee will be instituted for application approval less          Rush Fee                Rush Fee            Plus Additional $500 Rush Fee             activity will begin on your              Fee
 than 45 days before the activity date, plus an additional rush     Plus Additional         Plus Additional                If < 25 Days                       program approval date)          Plus Additional $500
 fee for application approval less than 25 days before the
                                                                   $500 Rush Fee If        $500 Rush Fee If                                                                                   Rush Fee If < 25 Days
 activity date.)
                                                                       < 25 Days               < 25 Days
 Online Hosting Fees for Enduring Materials Created                       N/A                     N/A                              N/A                                   N/A                 $100/hour Set-
 Outside the CME Office and Hosted on the CME                                                                                                                                                up/Educational
 Website.                                                                                                                                                                                    Materials/Test/etc.
                                                                                                                                                                                             Reimbursement of CC
                                                                                                                                                                                             Fees (3.0%)
                                                                                                                                                                                             $25/hour Reporting Fees
                                                                                                                                                                                                   $100/hour for
                                                                                                                                                                                               Correspondence Fees
  Commercial Support Letters of Agreement (LOA)
                      ***
 OU/CME Letters of Agreement (LOA):                                   No Charge               No Charge                       No Charge                              No Charge                      No Charge
 OU Legal has already approved our LOA and no additional
 CME staff time is required. Therefore, a fee is not charged.
 All Other Letters of Agreement (LOA):                             $100 each LOA          $100 each LOA               $100 each New LOA                           $100 each LOA                 $100 each LOA
 For OU/CME to sign a company’s LOA, the form must be                                                               Not covered under the first
 negotiated between OU/CME, OU Legal and the supporting
 company’s legal department. This can take numerous phone
                                                                                                                        application/series
 calls, emails and faxing between the legal departments often
 requiring verbiage changes and deletions to reach consensus
 from all entities. Therefore, we are charging $100 for each
 LOA that must go through this time consuming process.
** Residents, most do not use CME credits, therefore on the Basic Package, a per participant fee is not charged unless they return the CME certificate of attendance. When you select the Registration Package the residents
are exempt from the per participant fee which means the CME office will not register them, provide a certificate of attendance, provide credit, prepare name tags, or keep their records. If you wish any of these to be done
for your residents, there will be a participant charge of $25 each. However, we do need the number of residents who will be attending the activity so they may be provided with an evaluation form. ***Letters of Agreement
must be signed before the activity begins for acceptance of the commercial support funds. All commercial support funds must come through the CME Office. Exhibitor’s fees are considered commercial support.
 NOTES: Withdrawn or non-approved applications will be assessed a $500 Processing Fee. CME administrative fees are not refunded on canceled courses. $15.00 will be charged to all non-faculty individuals requesting
a CME transcript.
                                                                                         (See page two for administration of duties.)
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                                                                  Administration of Duties – Jointly Sponsored Activities
                                                                              (All activities developed outside the OU College of Medicine)
                                                              Live Conference Packages - Regularly Scheduled - Enduring Materials
                             Administration of Duties                                  Basic               Registration                   Series            Regularly Scheduled     Enduring Materials
                   “CME” represents CME office responsibilities                   Live Conference         Live Conference           Live Conference              Activities
                  “CD” represents Course Director’s responsibilities                                                              (Basic or Registration)
     *     Pre-Application Consultation (Application Forms, Timeline)                   CME                     CME                       CME                      CME                    CME
     *     AMA PRA Category 1 Credit(s) ™ (Approval of application,                     CME                     CME                       CME                     CME/CD                 CME/CD
           Record Credits, 6 Year Records Keeping)
     *     Evaluation Form and Summary                                                CME/CD                  CME/CD                    CME/CD                   CME/CD                    CD
     *     Certificate of Attendance or Letter of Credit                               CME                     CME                       CME                   Year-end/CME               CME
     *     Commercial Support (Letter of Agreement Documentation)                     CME/CD                  CME/CD                    CME/CD                   CME/CD                  CME/CD
     *     Joint Sponsorship Coordination                                              CME                     CME                       CME                       CME                    CME
                                        Registration
     *     Pre-Course Registration, Credit Card Service (3.0% Fee                        CD                     CME                      Basic-CD                   N/A                  CME/CD
                                                                                                                                      Registration-CME
           charged by Credit Card Co.)
           On-site Registration at Conference                                            CD                      CD                      Basic-CD                   CD                   CME/CD
                                                                                                                                       Registration-CD
           Standard Name Tags                                                            CD                     CME                      Basic-CD                   N/A                     N/A
                                                                                                                                      Registration-CME
           Weekly or Monthly Enrollment Reports                                          CD                     CME                      Basic-CD               Year-end/CD              CME/CD
                                                                                                                                      Registration-CME
           On-site Registration Book, Instructions and Receipt Book                      CD                     CME                      Basic-CD                   N/A                     N/A
                                                                                                                                      Registration-CME
                                          Publicity
     *     Review and Approval of Brochure/Flyer                                        CME                     CME                           CME                  CME                     CME
     *     CME Home Page                                                                CME                     CME                           CME                  CME                     CME
                                 Conference Coordination
     *     Submit with application the completed disclosure forms for the                CD                      CD                           CD                    CD                      CD
           Course Director, Planning Committee and Course Contact.
           Before approval of your syllabus and total AMA PRA Category 1
           Credits™ can be determined and granted all disclosures for each
           Speaker/Moderator and Panelists must be submitted to the
           CME office for review and approval.
                                          Syllabus
     *     Before printing the syllabus/handout, you must submit to the                  CD                      CD                           CD                    CD                      CD
           CME office for review and approval, the sections of the
           syllabus/handout that contain the following information: Faculty
           Disclosure Report (to include each Speaker/Planner/Moderator/         (Approval required          (Approval            (Approval required by     (Approval required by   (Approval required by
           Panelists/Course Contact); Objectives; Accreditation Statement;       by the CME office)        required by the          the CME office)           the CME office)         the CME office)
           Acknowledgement of Commercial Support (if applicable) and the                                    CME office)
           American Disabilities Act Statement.
                                     Financial Support
           Preliminary Budget and Final Reporting                                     CME/CD                  CME/CD                    CME/CD                     CME                   CME/CD
     *     Speaker Travel/Honoraria Processing without Commercial                       CD                      CD                        CD                         CD                    CD
           Support
     *     Speaker Travel/Honoraria Processing with Commercial                          CME                     CME                           CME                 CME/CD                 CME/CD
           Support
* Indicates areas, which require compliance with ACCME Essentials and Standards and thus, require coordination with and involvement of CME Staff.

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                                                        CME Administrative Fees – Directly Sponsored Activities
                                                                                  (Department of OUHSC/College of Medicine)


           Live Conference Packages -                                 BASIC                REGISTRATION                          SERIES                   REGULARLY              ENDURING MATERIALS
                                                                  Live Conference           Live Conference          Live Conference Package Fee          SCHEDULED                   Package Fee
             Regularly Scheduled –                                 Package Fee *             Package Fee *              (Basic or Registration)          Activities Package        (CME on CD, DVD,
                                                                 (See page two for the    (See page two for the        Application approval is for               Fee              Monograph, Online, etc.)
               Enduring Materials                                  Administration of     Administration of Duties)      one year. To qualify as a         (Grand Rounds)
                                                                        Duties)                                      series, the content must be the
                                                                                                                     same; additional offerings can     Annual Application
                                                                                                                     be held in different locations,        Fee Covers
                                                                                                                      multiple times. For the first     Accreditation From
                                                                                                                      offering, refer to the basic or   July 1 through June
                                                                                                                     registration package fee*, for              30
                                                                                                                     each additional offering in the
                                                                                                                      series, refer to prices below.
    Fee for each Registrant (fee collected after the program)            $25                       $25                              $25                         N/A                         $25
     (** Residents)
    CME Administrative Package Fee (submit fee with                    $1,000                    $2,000               First offering see Basic or       $0.00 No Commercial                $1,500
    application)                                                                                                      Registration Package Fee*             Support
                                                                                                                      (Each additional offering)           $300 with                  $350 Reapplication
                                                                                                                          $200 each (Basic)             Commercial Support
                                                                                                                       $500 each (Registration)
    CME Administrative Application Late/Rush Fee’s                < 45 Days $500         < 45 Days $500 Rush          < 45 Days $500 Rush Fee           N/A (Credit for your     < 45 Days $500 Rush Fee
    (A rush fee will be instituted for application approvals       Rush Fee Plus          Fee Plus Additional         Plus Additional $500 Rush         activity will begin on   Plus Additional $500 Rush
    less than 45 days before the activity date, plus an           Additional $500        $500 Rush Fee If < 25             Fee If < 25 Days                 your program              Fee If < 25 Days
    additional rush fee for application approvals less than 25    Rush Fee If < 25               Days                                                       approval date)
    days before the activity date.)                                    Days
    Online Hosting Fees for Enduring Materials Created           N/A                     N/A                         N/A                                N/A
                                                                                                                                                      $100/hour Set-up/Educational
    Outside the CME Office and Hosted on the CME                                                                                                      Materials/Test/etc.
    Website.                                                                                                                                          Reimbursement of CC Fees
                                                                                                                                                      (3.0%)
                                                                                                                                                      $25/hour Reporting Fees
                                                                                                                                                      $100/hour for
                                                                                                                                                      Correspondence Fees
** Residents, most do not use CME credits, therefore on the Basic Package, a per participant fee is not charged unless they return the CME certificate of attendance. When
    you select the Registration Package the residents are exempt from the per participant fee which means the CME office will not register them, provide a certificate of
    attendance, provide credit, prepare name tags, or keep their records. If you wish any of these to be done for your residents, there will be a participant charge of $25.
    However, we do need the number of residents who will be attending the activity so they may be provided with an evaluation form.

    Commercial Support Letters of Agreement (LOA)                                                        NOTES:
    - All commercial support funds must come through the CME Office.                                     - Withdrawn or non-approved applications will be assessed a $500 Processing Fee.
    - Exhibitor’s fees are considered commercial support.
                                                                                                         - CME administrative fees are not refunded on canceled courses.
- Letters of Agreement must be signed before the activity begins for acceptance of
                                                                                                         - $15.00 will be charged to all non-faculty individuals requesting a CME transcript.
    the commercial support funds

                                                                          (See page two for administration of duties.)




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                                                         Administration of Duties – Directly Sponsored Activities
                                                                                  (Department of OUHSC/College of Medicine)
                                                         Live Conference Packages - Regularly Scheduled - Enduring Materials
                                       Administration of Duties                                            Basic            Registration                Series           Regularly           Enduring
                                                                                                           Live            Live Conference               Live            Scheduled           Materials
“CME” represents CME office responsibilities                                                             Conference                                   Conference         Activities
“CD” represents Course Director’s responsibilities                                                                                                     (Basic or
                                                                                                                                                      Registration)
* Pre-Application Consultation (Application Forms, Timeline)                                                CME                  CME                     CME               CME                CME
* AMA PRA Category 1 Credit(s) ™ (Approval of application, Record Credits, 6 Year Records                   CME                  CME                     CME              CME/CD             CME/CD
  Keeping)
* Evaluation Form and Summary                                                                             CME/CD               CME/CD                  CME/CD                CD              CME/CD
* Certificate of Attendance or Letter of Credit                                                            CME                  CME                     CME                 CME                Year-
                                                                                                                                                                                             end/CME
* Commercial Support (Letter of Agreement Documentation)                                                  CME/CD               CME/CD                  CME/CD             CME/CD             CME/CD
                                               Registration
* Pre-Course Registration, Credit Card Service (3.0% Fee charged by Credit Card Co.)                         CD               Basic-CD                   CME              CME/CD                N/A
                                                                                                                           Registration-CME
   On-site Registration at Conference                                                                        CD               Basic-CD                    CD              CME/CD                CD
                                                                                                                            Registration-CD
   Standard Name Tags                                                                                        CD               Basic-CD                   CME                 N/A                N/A
                                                                                                                           Registration-CME
   Weekly or Monthly Enrollment Reports                                                                      CD               Basic-CD                   CME              CME/CD           Year-end/CD
                                                                                                                           Registration-CME
   On-site Registration Book, Instructions and Receipt Book                                                  CD               Basic-CD                   CME                 N/A                N/A
                                                                                                                           Registration-CME
                                                 Publicity
* Review and Approval of Brochure/Flyer                                                                     CME                  CME                     CME                CME                CME
* CME Home Page                                                                                             CME                  CME                     CME                CME                CME
                                        Conference Coordination
* Submit with application the completed disclosure forms for the Course Director, Planning                   CD                   CD                      CD                 CD                 CD
  Committee and Course Contact. Before approval of your syllabus and total AMA PRA Category
  1 Credits™ can be determined and granted all disclosures for each Speaker/Moderator and
  Panelists must be submitted to the CME office for review and approval.
                                                 Syllabus
* Before printing the syllabus/handout, you must submit to the CME office for review and                     CD                   CD                      CD                 CD                 CD
  approval, the sections of the syllabus/handout that contain the following information: Faculty
  Disclosure Report (to include each Speaker/Planner/Moderator/ Panelists/Course Contact);
  Objectives; Accreditation/Resolution Statement; Acknowledgement of Commercial Support (if               (Approval       (Approval required        (Approval         (Approval required     (Approval
  applicable) and the American Disabilities Act Statement.                                               required by      by the CME office)      required by the     by the CME office)   required by the
                                                                                                           the CME                                 CME office)                              CME office)
                                                                                                            office)
                                            Financial Support
  Preliminary Budget and Final Reporting                                                                  CME/CD               CME/CD                  CME/CD             CME/CD               CME
* Speaker Travel/Honoraria Processing without Commercial Support                                            CD                   CD                      CD                 CD                  CD
* Speaker Travel/Honoraria Processing with Commercial Support                                              CME                  CME                     CME               CME/CD             CME/CD
  * Indicates areas, which require compliance with ACCME Essentials and Standards and thus, require coordination with and involvement of CME Staff.




D:\Docstoc\Working\pdf\af73d6da-5d36-4f6f-8a57-4308dfcf3d5c.doc                                                                                                                                              16

				
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