Evaluation (Continued) (Completion of this form is mandatory)
MDPA2326
To receive continuing education credit, completion of this Evaluation is mandatory. Last Name ____________________________________________ First Name _ ___________________________________ MI _ _____ State ____________________________ License # _______________________________________ Expiration Date _ _____________
MDPA03CA - Child Abuse Identification and Reporting: The Pennsylvania Requirement — If you answered YES to question #12, how specifically will this activity enhance your role as a member of the interdisciplinary team? ___________________________________________________ ________________________________________________________________________________________________________________ MDPA05OS - Opioid Safety: Balancing Benefits and Risks — If you answered YES to question #12, how specifically will this activity enhance your role as a member of the interdisciplinary team? _______________________________________________________________________ ________________________________________________________________________________________________________________ MDPA02OT - Supporting Organ and Tissue Donation in Clinical Settings: The Pennsylvania Requirement — If you answered YES to question #12, how specifically will this activity enhance your role as a member of the interdisciplinary team? ___________________________________ ________________________________________________________________________________________________________________ MDPA05BP - Burnout in Physicians — If you answered YES to question #12, how specifically will this activity enhance your role as a member of the interdisciplinary team? ___________________________________________________________________________________________ ________________________________________________________________________________________________________________ MDPA03FP - Falls and Fall Prevention — If you answered YES to question #12, how specifically will this activity enhance your role as a member of the interdisciplinary team? _________________________________________________________________________________________ ________________________________________________________________________________________________________________ MDPA05RM - Risk Management — If you answered YES to question #12, how specifically will this activity enhance your role as a member of the interdisciplinary team? ___________________________________________________________________________________________ ________________________________________________________________________________________________________________
Signature ________________________________________________________________________________ Signature required to receive continuing education credit.
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MDPA2326
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