Application and Guidelines
CME Application, Conflict of Interest and Annual Disclosure Forms
Fill in Application Forms (MS Word)
After opening an application, save to your pc, fill in the blanks, then save your work. Either print out and inter-office mail the application or you can email it to James Orlando, EdD at the CME office firstname.lastname@example.org.
- CME Application – Initial
Use this application for ANY CME Program request.
- RSS-Event Specific Program CME Credit Application
Use this form for previously approved CME programs whose events occur on a regular basis such as Grand Rounds,Tumor Board, M&M, PI, QI, P&T, etc. This application is to be submitted for EACH time the event is held to Delroe Livermore. If the event title for that date remains as TBA (To Be Announced) then the CME Office did not receive your application and therefore your event will not receive CME credit.
- Annual Disclosure Letter
Required of All Speakers and Program Planners
- Conflict of Interest Form
Professional Practice Gap
Construction Samples (PDF)
CME Behavioral Objective Construction
Guidelines & Appropriate Verb Listing (PDF)