Long Track Tracking Form

2011 EMR Long Track Course

(Contact Ohio ACEP by calling (614) 792-6506 to redeem CME for a previous year's course.)
August 22-26, 2011
September 19-23, 2011
It is possible to earn up to 73 hours of AMA PRA Category 1 CreditsTM for the Long Track Course.
It is the responsibility of each registrant to keep track of the hours he/she has spent on each portion of this course. Physicians should claim only credit commensurate with the extent of their participation in the activity.
You must complete the form below to receive a CME certificate. You should receive it by e-mail within 14 business days after submitting your hours.
If you submit information and do not receive your CME certificate, first please check your spam/junk mail folder, then call or e-mail the Ohio ACEP office; please DO NOT resend your request. Thank you.
2011 EMR Long Track Course
First Name
Last Name
Credentials (MD, DO, FACEP, FACOEP, RN, PA, etc.)
Address1
Address2
City
State
Zip
Country
Preferred Phone Number
Alternate Phone Number
E-mail Address
Course Attended
Hours Available/Hours Spent
Didactic Lectures 47
Patient Photos 10
Patient X-Rays 10
X-Ray Cases 6
Total Hours Available: 73 Total Hours Reported
   - denotes required fields